Bouquet Subscription Form

Cottage Garden Treasures
2010 Season Bouquet Subscription Order Form

Subscription: 10 bouquets X $12.50/bouquet = $125.00 plus tax/delivery/S&H if applicable
(10 weeks from July – Sept. unless spring and/or fall bouquets requested)

Flower Preferences:
What is/are your or recipient’s favorite flower(s)?:
What color of flowers do you or recipient like?:
Do flowers need to coordinate with specific color scheme or room? (please list):
___________________________________________

Delivery Information:
Recipient’s First & Last Name:________________
Address where flowers are to be delivered:_
City: _ ST Zip:
Home Phone: Cell Ph: Work Ph:_
Email address:______________________________
Location where flowers should be left if you or recipient is not home:

Billing Information: (Complete if different than delivery information)
First & Last Name:______
Address:_
City:_ ST Zip:
Home Phone: Cell Ph: Work Ph:_
Email address:____________________________________________________

Payment:

Bouquet Subscription	$	125.00
Beloit Sales Tax: .07 x $125.00	$	8.75
Subtotal	$	133.75
Delivery: (# of miles:_____ x $.50 = __________) x 10 bouquets = ^{(delivery charge only applies to deliveries outside Beloit city limits)}	$	________
Shipping and Handling (please contact for charges if bouquets needs mailed)	$	________
TOTAL	$	________
Return completed form and payment to: Cottage Garden Treasures 900 N. Hersey Beloit, KS 67420 Thank You!