CBW FLOWERS & GIFTS - ORDER FORM
Please print and fill out the following order form and fax it to one of the following numbers:

Los Angeles Fax Number: (626) 458-8434
Beijing Fax Number: (010) 8463-4872 (If faxing from outside of China, pleas dial 86-10-8463-4872)
For payment questions, please email us at or see the Payment Information page.
*Please note that if an item you selected is not available in the destination country, it will be replaced with a smilar item of equivalent value.


SENDER INFORMATION
Sender's Last Name: First Name:
Telephone No. : Fax No.:
Email:
Sender's Address:
City: State: Zip: Country:
  Item Code No. Item Description Price (USD)
1.  
2.  
3.  
4.  

Please Add $15.00 if paying by T.T. (Telegraph Transfer or Wire)

   
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TOTAL:$

 
RECIPIENT INFORMATION (if sending to multiple recipients, please print addional Order Forms)
Recipient Last Name: First Name:
Telephone No. : Fax No.: Email Address:
Recipient's Address :
City: State: Zip: Country:
Requested Delivery Date: (MM)/ (DD) / (YY)

Message to be included with flowers/gifts:

Payment Method:
Credit Card Money Order Postal Remittance Check T.T. (Telegraph Transfer/Wire) Cash
IF PAYING BY CREDIT CARD  
Please note that your charge will show up as by ASM Overseas Corporation, not CBW Flowers & Gifts, on your bill.
Credit Card Type: (no other cards accepted at present) Visa Master Card American Express
Credit Card Number: Expiration Date: (MM)/ (YY)
Amount to be charged:
Billing Address:
City: State: Zip: Country:
I hereby authorize ASM Overseas Corporation to charge the above-mentioned sum to my credit card account.
CARD HOLDER'S AUTHORIZATION SIGNATURE: X Date:
 

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