Order

CBW FLOWERS & GIFTS - ORDER FORM
Please print and fill out the following order form and fax it to one of the following numbers:

Los Angeles Fax Number: (626) 458-8434
Beijing Fax Number: (010) 8463-4872 (If faxing from outside of China, pleas dial 86-10-8463-4872)
For payment questions, please email us at or see the Payment Information page.
*Please note that if an item you selected is not available in the destination country, it will be replaced with a smilar item of equivalent value.

SENDER INFORMATION

Sender's Last Name: First Name:

Telephone No. : Fax No.:

Email:

Sender's Address:

City: State: Zip: Country:

	Item Code No.	Item Description	Price (USD)
1.
2.
3.
4.
Please Add $15.00 if paying by T.T. (Telegraph Transfer or Wire)
¡¡	¡¡	TOTAL:$

RECIPIENT INFORMATION (if sending to multiple recipients, please print addional Order Forms)

Recipient Last Name: First Name:

Telephone No. : Fax No.: Email Address:

Recipient's Address :

City: State: Zip: Country:

Requested Delivery Date: (MM)/ (DD) / (YY)

Message to be included with flowers/gifts:

Payment Method:

Credit Card Money Order Postal Remittance Check T.T. (Telegraph Transfer/Wire) Cash

IF PAYING BY CREDIT CARD

Please note that your charge will show up as by ASM Overseas Corporation, not CBW Flowers & Gifts, on your bill.

Credit Card Type: (no other cards accepted at present) Visa Master Card American Express

Credit Card Number: Expiration Date: (MM)/ (YY)

Amount to be charged:

Billing Address:

City: State: Zip: Country:

I hereby authorize ASM Overseas Corporation to charge the above-mentioned sum to my credit card account.

CARD HOLDER'S AUTHORIZATION SIGNATURE: X Date: