PLACE YOUR ORDER

             RECIPIENT'S

          NAME:  

         ADDRESS:  

           CITY:  

          PROVINCE:  

   PHONE #:  

                           CARD MESSAGE:                                     

       COLORS  1st & 2nd CHOICES:

           SENDERS

       NAME:  

ADDRESS: 

        CITY:  

        PROVINCE:  

      POSTAL CODE:  

        PHONE #:  

                               DELIVERY DATE: