Fax Order Form to Vita Int'l for Graceful Cradle (412) 732-9030
Shipping Address: Please print clearly.
Name: _________________________________________________
Street: _________________________________________________
City: __________________ State: _________ Zip: ______________
Home Phone #: (______)_________________________________
Daytime Phone #: (______)_________________________________
Event Date: _______________E-mail address for fax confirmation: ________________________________
How did you hear about us? ______________________________________
If different than above... EXACT Billing Address:As is appears on your credit card statement.
Name: _________________________________________________
Street: _________________________________________________
City: __________________ State: _________ Zip: ______________
Credit card number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration date (month/year) __ __ /__ __ Card Code __ __ __
Number of Bouquet Displays with GRACEFUL CRADLE only _____________
Bouquet Display Total @ $8.00 Each __________.___
Regular Shipping $1.00 Each __________.___
Click Here for Priority and Express shipping details.
Priority shipping $4.00 additional __________.___
Express shipping $18.00 additional __________.___
Sub-total __________.___
PA residence only, 7% sales tax to total order __________.___
Total Order __________.___
With regular shipping, you will receive your order within two weeks. THANK YOU!