FLORAL DIRECTORY LISTING ORDER FORM

(for secure version, please click here)

To order or renew your listing in the floral directory, please fill in and submit the form shown below.

Fill in all areas and be sure to press the SUBMIT button at the end of the form to send your order. 

ORDER SELECTION:

Directory listing - $ 14.95/month (reg $29.95)
        Options (check all that apply):
Bold listing -                      FREE  (reg $19)       
Website link -                      FREE  (reg $19)
Additional city listings (up to 4) FREE  (reg $9 ea.)

     If you ordered extra cities, please specify names below:

      
      

LISTING INFORMATION (Fields in red are required):

Shop name:       
Contact name:    
Business Address:
City:             State: Zip:
Local Phone No.  
Toll-free No.    
Fax No.          
Website:          (we link DIRECT to your website)
E-mail address:  

PAYMENT INFORMATION:

Credit card type:     
Credit card number:
Expire date:       Month:   Year:
Name on card:     
Billing Address:  
Billing City:      State: Zip:

   

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