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Order Form

Please print clearly to ensure correct delivery, and make sure to complete all five steps.

Step One - Ordered By:

First Name___________________ Last Name_____________________

Company Name_____________________________________________

Address (UPS cannot deliver to PO boxes, please provide a street address)

Street Address______________________________________________

City______________________________ State____ Zip_____________

Daytime Phone: Mon.- Fri. Must be included on all packages:
(____) _______________

E-mail (optional) ____________________________________________

Step Two - Ship to (if different from above):

First Name___________________ Last Name_____________________

Company Name_____________________________________________

Address (UPS cannot deliver to PO boxes, please provide a street address)

Street Address______________________________________________

City______________________________ State____ Zip_____________

Daytime Phone: Mon.- Fri. Must be included on all packages:
(____) _______________

Step Three - Item Description and Quantity:

Back Orders:  If we are out of stock, may we backorder items for you?
Yes  No (circle one)

Note: Items will not be charged to your account until shipped.

Step Four - Payment Method (please do not send cash):

[ ] VISA or [ ] MasterCard

Credit Card Account Number _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _

Exp. Date _______ Signature____________________________

Print Name__________________________________________

[ ] CHECK Orders paid by personal check will be sent after check clears.

Step Five - mail to:

Earth Arrangements
2109 39th Street
Bellingham, WA 98226 USA

Thank you for your order

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