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FLORAMEX Giro/Western Union/MoneyGram/Direct Deposit ORDER FORM/FORMA

http://www.floramex.com Email: sales@floramex.com Tel: +52(322)49181 Fax: +52(322)48966, En Mexico Tel.01-322-49181 Fax 01-322-48966
Your E-mail/su email > fields w/red required/flechas rojas requeridas
Your Name/su Nombre >
# of Giro, WesternUnion, ElektraGiro, AmericanExpressMoneygram#, BanamexDepositDate(fax su ficha) >
Your Day phone(inc.areacode)Su tel.de dia,inc.lada >
Eve.phone(inc.areacode/Su tel.de noche,inc.Lada >
Mexicana Air Programa Frecuenta #
Delivery Date/Dia de Entrega >
Recipient Name/Para entregar a >
Company Name/Nombre de Empresa
Address/Direccion >
Col/Fracc./Sector/Suburb
Your comments if any/su comentario si hay
City/Cd >
State/Edo/Prov >
Zip/CP >
Country/Pais >
Tel.incl.areacode/Tel incl.lada >
Flowers Wanted/flores Solicitada >
Price U.S.D$/precio en US$ >
Brief Card Message/Mensaje corto en la tarjeta >



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