BLOEMSIERKUNST COIN FLEURI

FLOWERSHOP COIN FLEURI

ORDERFORM

Bouquet Flower
composition Plant Occasional
flowers

Amount
EUR

+7,50 Eur delivery costs Knokke-Heist
+9,50 Eur delivery costs Belgium

Card

Text

Please enter your personal text here

Delivery details

Delivery-date

Home delivery in Knokke-Heist on the day of ordering
can only be guaranteed if ordered before noon.

Closed on Tuesday and Wednesday

Deliveries:
Week-days from 9 - 12h. and 15 - 18h.
Saturday from 9 - 12h. and 15 - 18h.
Sunday from 10 - 12h.

Name

Adress

Post Code

Locality

SENDER

Name

Address

Post Code

Locality

Phone

E-mail

PAYMENT

Way of payment:
Credit card -- Details: by phone at number 050/60 35 51
Credit card -- Details: by tax at number 050/62 83 38
Credit card -- Details: hereunder

Creditcard

Card number

Expiry date

Card Valid Code 3
    The last 3 ciphers near signature back card

On account (for well-known customers only !)

Please check your order!
Checkbox:

Way of payment:	Credit card -- Details: by phone at number 050/60 35 51 Credit card -- Details: by tax at number 050/62 83 38 Credit card -- Details: hereunder
Creditcard
Card number
Expiry date
Card Valid Code 3	The last 3 ciphers near signature back card
	On account (for well-known customers only !)