Order Form

PLEASE NOTE! You MUST give us your E-MAIL address, day PHONE and night PHONE, fill out yellow boxes, and Address to have a Guaranteed ORDER, please.

Open M-F 9am to 5pm Sat by Appointment
NOTE Order need to be sent before 1pm for same day delivery

Selected Bouquet AMF-MD2-16 

PRICE $45.00 + Delivery

 

Delivery Date :
Send To :  
Name
Company Name
Address
Suite or Apartment # 
City
State
Zip
Country
Home Phone  Work Phone
Any special instructions

 

Enclosure card to reads...

 

Bill it to

 

Name
Your Email Address

Business Name
Address
Suite or Apartment #
City
State
Zip
Phone Num
Alt Phone Num

Do you have a Pre-establish Anderson McIlnay Account (Yes or No)

If you have a Account then you do not need to fill our bankcard information,

unless you want to bill your order on a bank card.

BANK CARD

Method of payment? 

Bank Card Account Number

- - -

Bank Card Expire Date 

Bank Card ID CODE

Visa/MasterCard/Discover 3 Digits
American Express 4 Digits

 

We will send you Email and confirm this order. PLEASE call us ASAP if you do not get a email within 30 minutes of placing an order.
 
All selections could vary, subject to supply on hand, price is subject to change without notice.
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Reach us by e-mail CLICK HERE for EMAIL or call 1-503-364-9770 or send postal mail to

409 Court St NE Salem, Oregon 97301