The Fruit Basket Company Fax Order Form

Fax (202) 544-0326
Phone (202) 544-7400

Today's Date __/__/__

Sold to Information:
Name:__________________________        email _______
Company:__________________________
Address: __________________________
Phone:     (_____)_____________________
Credit Card # ______________________________ Exp. Date __/ ___

Method of Payment  (Circle one)
Visa   MasterCard   Amex  Discover Diners

Recipient Information:
Delivery Date: _________
Send to:_________________________________________
Company Name __________________________________
Address: ___________________________
Suite or Apartment #___________________
Phone ( ___)__________________________
Message on enclosure card: __________________________

Product Information
Name or Item # to send__________________________________________
Special Instructions:    ___________________________________________

Thank you!

Upon receipt of your order we will confirm your order as well as the price including delivery and tax. Would you prefer us to contact you by:

(Choose one)   Phone_____  Fax______  Email______