ORDER FORM

 

TODAY’S DATE:__/__/__                                  

    

COUNTRY OF DESTINATION: _____________________________________________
EXECUTING MEMBER: _____________________________________________
DELIVERY DATE: _____________________________________________
RECIPIENT ‘S NAME: _____________________________________________
RECIPIENT ‘S ADDRESS:

_____________________________________________

 

_____________________________________________

 

_____________________________________________

 

_____________________________________________

 

TELEPHONE NUMBER: _____________________________________________
FLOWERS/PRODUCT CODE: _____________________________________________
VALUE: ___________RINGGIT MALAYSIA / FLEURINS /DOLLAR
MESSAGE:

_____________________________________________

 

_____________________________________________

 

_____________________________________________

  

MEMBERSHIP NO.: 6063_________________________________________
NAME: AL’CAPRICORN FLORIST
ADDRESS:

11 & 12, Jalan Cahaya 11, Taman Cahaya,68000 Ampang,

Selangor, Malaysia.

Tel:  603- 92855625 

Fax: 603- 92022251 

HP: 012- 2027289 

WEBSITE: http://www.alcapricorn.com.my
EMAIL: alice.alcapricorn@gmail.com
OTHER INSTRUCTIONS:     _____________________________________________

ORDER BY : -  

 

BILL TO : -