Riverview Florist Fax Order Form
Company Phone# 1-800-208-1277
Local Phone# 1-734-282-1277
Fax Phone# 1-734-282-1301

TO: Riverview Florist
Card Holder Name and Address
DATE:

Your Phone Number:
  
Product SKU#s
Credit Card Type

  Master Card
  Visa
  Discover
Credit Card Number


Expiration Date

Recipients Name:

Phone #

Address:

City:

State:

Zip Code:

Special Instructions:
Notes on Cards Etc: