Jim Ludwig’s Blumengarten
Phone number: (412) 281-3322 or 1-800-BLUMEN-5   FAX number: (412) 281-3319

(To print this form, go to file, and select print. Fill out the form, and FAX it to 412-281-3319.  Or, copy this form to your computer’s text editor, fill in your information, print it to your computer’s fax, and fax it to 412-281-3319.)

Please include all of the following information:
Today’s date:

Delivery date: (Sorry, delivery not available on Sundays.)

Your name:
Your address:

Daytime phone:
Evening phone:
FAX number:
E-mail address:

Please charge to credit card number:
Credit card expiration date:

Deliver to (Recipient’s name):
Company name (if applicable):
Street address (MUST include zip code):

Recipient’s phone number:
Are there any special delivery instructions?

Description of what you would like to send:

Price level (tax and delivery charges will be added):
Message for the card:


Thank you for your order. We will phone, FAX, or e-mail confirmation that we received this order.
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