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Name:
Contact Number: (Mobile Preferred)
Address:
Email Address:
Name of Floral Design Required:
Value: (Delivery Extra)
Addons	Glasshouse Candle - $43 Moet or GH Mumm French Champagne - $55 Mothers Day Cards - $7 Helium Foil Balloon - $15
Total	$60
Recipients Name:
Delivery Address:
Recipients Phone Number:
Delivery Date:
Card Message:

PLEASE NOTE: We will contact you to confirm your payment details.