EmailMe Form - Gourmet Gift Basket Order Form

Today's Date

MM / DD / YYYY

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Email

Delivery Date & Time

MM / DD / YYYY HH : MM AM/PM

Basket Package
(Base Price)

Platinum - $48 (X-Large)

Gold - $36 (Large)

Silver - $24 (Medium)

Bronze - $16 (Small)

Cake Choice

Pie Choice

Caramel Crumble Apple

Sweet Potato

What is the occasion for which the gift basket is being given?

Other Occassion

For Anniversary: How many years?

For Birthday: What is the age?

For Other: What is the occasion?

Recipient name(s)

What colors would you like used?

Tea Choices

Special Instructions

Delivery Options

Pickup - Free (Pickup location - 9701 Apollo Drive, Suite 100, Largo, MD 20774. If orders are not picked by the deadline of the delivery day and and arrangements are made for a delivery to the customer, a fee will be charged)

Delivery Fee - $5.00 to $10.00 (Depends on distance)

Shipping Address

E-Mail List

Please add me to the email list

I am already on the email list

I do not want to be added to the email list