Flowerfarm Customer Service
Fax: 81-3-5329-1287 Tel: 81-3-5355-1391
1, Sender Information
Name Mr. / Ms.
Date of Order      /     /20    (mm/dd/yyyy)
E-mail
Contact Number
Tel:
Fax:
Address
   
  State:

Country:

2, Recipient Information
Name Mr. / Ms.
Contact Number Tel: +81-
Address
 
City: Prefecture:
Postal Code:
Country: JAPAN only

3, Order Request
Product Please refer to our product catalogues on website.
Product Name Price \
Message
Card
□ message card  □ board  (Available Items Only)
To:
Message(within 30 words)
From:
Requested Delivery Date & Time
     /     /20    (mm/dd/yyyy)
□Morning □14:00 to 16:00 □16:00 to 18:00
□18:00 to 20:00 □19:00 to 21:00

4, Payment
Credit Card
Payment
Card holder  
Card no.
Exp.date | CSC        /          |  

Thank you for your order.
Please check this form before sending to avoid wrong delivery.
If you have any question, please feel free to contact us.