XQZT FLORAL DESIGN
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XQZT Floral Fundraising Program
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Please fill in the form below, you will receive an e-mail with payment details if you are placing an order. Thank you for your subscription or inquiry.
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Indicates required field
Name
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First
Last
Email
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Phone Number
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Please provide us with a phone number to contact you at. This is especially important for those wanting subscriptions.
Please add an inquiry or Comment here for general information
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Bouquet Subscription Information
If you are interested in sending a 4 week bouquet subscription, please fill out the form below and we will e-mail you payment information which can be done by e-transfer, or indicate below that you would like us to call you in order to receive your credit card information over the phone.
Payment Information
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E-mail e-transfer payment information
Please call me directly to receive credit card information for payment
Please indicate if you would like us to e-mail to you our e-transfer instructions, or if you would like us to call you directly to receive credit card payment over the phone.
Phone Number of Sender
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If you would like us to phone you in regards to payment information please fill in your phone number here. We accept Visa and Master Card.
Recipient's Information for Floral Subscription
Recipients Name
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First
Last
Please enter the name of the individual who is receiving the floral subscription. If there is more than one name please use the comments box to add additional names to the order.
Recipients Phone Number
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Please enter a phone number or a cell phone number at which the recipient can be reached
Select for Delivery or Pick Up of Bouquet Subscription Order
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Delivery
Pick Up At XQZT Floral 29 Brock Street West, Tillsonburg
Please choose if you would like to have your subscription delivered or pick up at XQZT Floral located at 29 Brock Street West in TIllsonburg.
Bouquet Subscription
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Subscription 1- $25.00*4=$100.00
Subscription 2-$35.00*4=$140.00
Subscription 3-$50.00*4=$200.00
Subscription 4-$60.00*4=$240.00
Please pick the subscription you would like to have sent. Price includes tax, but not delivery.
Recipients Cell Number
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Choose a Delivery Frequency
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Weekly
Bi-Weekly
Monthly
Please choose a delivery schedule should you be having your bouquet subscription delivered. Weekly deliveries are completed on Wednesday's, for Monthly deliveries please indicate in the comment box below which day of the month you would like the bouquets delivered.
Address
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Line 1
Line 2
City
State
Zip Code
Country
Delivery Charges
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Delivery in Tillsonburg/Courtland $5.00*4=$20.00
Delivery Outside of Tillsonburg $10.00*4=$40.00
Please pick on of the delivereis option and it will be added to your total. Rual routes in Tillsonburg and Courtland are included in the $5.00 areas'
Comment
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Please leave any questions or further information you would like us to have in this section. If you would like to add a card message to your bouquet subscription please enter it here and we will put this card on each of your bouquet deliveries.
Choose An Add On
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$10.00 Vase For First Bouquet
$10.00 Vase For Half of Bouquets Total $20.00
$10.00 Vase for All Bouquets Total $40.00
Please select the following up-grades should you like to have a vase included.
I agree to receiving marketing and promotional materials
Submit
Home
About
XQZT Floral Fundraising Program
Decoration Day
Funeral Tributes
Wedding Flowers
Everyday Floral Arrangements
Seasonal Floral Arrangements
Floral Subscription
Mother's Day
Questions and Inquiries
Contact
Blog