Fax Order Form
Paradise Flower Farms Fax Order Form - Fax: (808) 878-1864
Please reprint this form for each order that is to be shipped to a different address. 
Please ensure that all fields are completed. (You may also email us the same details shown below.)

NAME:
COMPANY:
ADDRESS:
PHONE:		EMAIL:
MASTERCARD/VISA#:		EXP. DATE:
NAME ON CREDIT CARD:
Ship to NAME - (If different than above):
Ship to COMPANY:
Ship to ADDRESS:
Recipient's PHONE:
GREETING CARD MESSAGE:
DATE TO RECEIVE SHIPMENT:
QUANTITY	ITEM DESCRIPTION	PRICE EA.	TOTAL
PACKING BOX, SHIPPING AND TAX TO BE FIGURED BY US.