FAX ORDER/PEDIDO
Fax to: Within (en) Mexico SIN
COSTO: 01-800-715-9901 OR
Fax our Mexico office direct from U.S.A. 011-52-322-224-8966 OR
Fax or
Call our USA office direct: 702-446-5717, OR From Other countries:
+52-322-224-8966
Telephone/Telefono: Dentro Mexico sin costo 01-800-714-7841,
From USA to Mexico: 011-52-322-224-9181
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- Day of Delivery/Dia de Envio______________ (No
Sunday deliveries/No Hay Entregas los Domingos)
- Name of Recipient/Para Entregar A:
_______________________________________________________________________
- Street
Address/Direccion:_________________________________________________________
- Colonia/Fracc/Suburb:___________________________________________________________
- City/Ciudad:__________________________________State/Estado_______________________
- Zip Code/Codigo
Postal:_______________________Country/Pais:_______________________
- Tel. # & Area Code/Tel. y Lada (Very Important/Muy
Importante):__________________________
- Due to small size of floral cards a brief message on card/Mensaje
(breve)en la
Tarjeta:_______________________________________________________________________
- _____________________________________________________________________________
- Items requested/Regalos Solicitados:________________________________________________
- What Occasion if
any/Ocasion:___________________________________________________
- Total Amount in U.S. dollars/Precio en U.S.
dolares:___________________________________
-
- Your Information Please (Para Facilitar este pedido, sus datos por
favor):
-
- Your name/su
Nombre:__________________________________________________________
- Address credit card is billed to/domicilio de
tarjeta_____________________________________
- ____________________________________
City/Ciudad_____________________________
- State/Estado___________________Zip/Codigo
Postal_____________Country/Pais__________
- Day Tel. #/Tel. en la Dia____________________ Eve Tel./Tel. En la
Noche________________
- Your email address/email direccion:________________________________
- Payment Method: VISA___MASTERCARD___AMEX/OPTIMA___DINERS___DISCOVER___
- Card Number/Tarjeta
Numero:___________________________________Exp.Date__________
- Optional: Primera Plus/ Siempre Plus Frequenta Traveler Membership
#:________________________
I hereby authorize Services On-Line Inc. dba Floramex, Las Vegas,
Nevada, USA to charge my credit card for this order/Por medio autorizo Services Online dba
Floramex acreditar a mi tarjeta para este pedido. Your Signature/Su firma:
__________________________Date/dia:__________