Thank you for choosing Regency Florists.
Please tell us who to deliver the arrangement to, and who you are.
Prices in Canadian dollars. Product may vary on availability
Delivery charged extra. Wire service charge $5.00
Order:
Order No. 1
Qty.
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2
3
4
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Order No. 2
Qty.
1
2
3
4
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Order No. 3
Qty.
1
2
3
4
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Order No. 4
Qty.
1
2
3
4
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From:
Name
Company
Address
City
Province/State
Postal/Zip Code
Country
Daytime Phone
E-mail Address
Deliver to:
Delivery Date
Delivery Time
Name
Company
Address
City
Province/State
Postal/Zip Code
Country
Daytime Phone
E-mail Address
Card Type
Click to Select Card Type
Anniversary
Birthday
Business
Funeral
Holiday
Newborn
Other
Message on Enclosure Card
Payment Method:
Click to Select
Visa
Master Card
American Express
For security purpose please call us
with your card number.
1-800-565-4834.
Or simply just submit the form with your
information's and one of our staff will contact you.
Or print this form and fax it to (519) 432-3915
