Please call (269) 985-9000 to place your order -- OR -- you may print this page, fill out form, and fax it to (269) 985-9001.

The following information is needed to process your order. Please have it ready for each gift when you contact us:

Your Name: _________________________________________________

Your Phone: _________________________________________________

Your E-mail: ________________________________________________

Gift is to be (circle one): Shipped via UPS / Delivered locally / Picked up

When, or how soon? ____________________________________________

Gift is to be sent to: ____________________________________________

Recipient's Address: ____________________________________________

Recipient's City/State/Zip: ________________________________________

Recipient's Phone Number: ________________________________________

Message for Enclosure Card: _______________________________________

(Don't forget to put the name or names of who is sending the gift!)

Your budget for the gift: $______ Please note that tax, delivery, and/or shipping charges will be IN ADDITION to this amount.

Visa/MC Number: ___________________________________________ Expiration Date: _______________ 3 digit code on back of card: ____ Name on Card: ________________ Address to where card is billed: _____________________________________________________________________________________________

List occasion and/or gift title (if you are ordering one of our standard baskets from the website): _____________________________________________

If this is a custom basket order, describe any specific items you would like in the basket if possible, likes/dislikes of recipient, and any other information that you feel is important to help us better customize their gift:

_____________________________________________________________________________________________

THANK YOU FOR YOUR ORDER!