Your Name *

First Name

Last Name

Your Phone Number *

(###)

###

####

Requested Date *

Please note that due to high demand we will be unable to accommodate exact time of day delivery requests, but all of our deliveries go out between 10am-4pm

MM

DD

YYYY

Delivery or Pick Up Request? *

Delivery charges will be added to your order request upon invoicing and begin at $12, going up from there depending on delivery address location.

Delivery

Pick Up at our Shoppe

Type of Request *

$60 MAMA GIFT BOX - includes petite arrangement, mama candle, chocolate bar, and card. *a larger arrangement may be added at additional cost.

$60 FLORAL ARRANGEMENT

$75 FLORAL ARRANGEMENT

$100 FLORAL ARRANGEMENT

$150 FLORAL ARRANGEMENT

Above $150 FLORAL ARRANGEMENT * Please note requested arrangement value in special details field below.

$40 wrapped bouquet. *available for in store pick up only.

Recipient Name (if delivery)

First Name

Last Name

Recipient Phone Number

(###)

###

####

Delivery Address *please note we do not deliver further than 13 miles from Fleurae shop location.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country