Order Form
Billing Information
Note: If paying by credit card, this billing information must match your credit card billing information
Last Name
First Name
Address
City
State
Zip
Email
Day Phone
(
)
-
Evening Phone
(
)
-
Date of Event:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
,
2010
2011
2012
Check if shipping information is the same as the information above.
Ship To
Shipping Address
City
State
Zip
Phone
(
)
-
Ordering:
Local Delivery / Customer Pick-Up (no shipping charge)
Monarchs
dozen
Check One
Pay entire balance now
Pay 50% deposit now
Additional Butterflies
individual
Accessories in your shopping cart
(Click to view and add accessories)
You do not have any items in your shopping cart. Please visit our
butterfly accessories page
to add items.
Shipping
$
Total
$
includes
shipping
Due now
$
Remaining balance
$
due 2 weeks prior to delivery
Special Instructions
Shipping:
Monarchs
Add
$39 priority overnight
$49 Saturday delivery
Accessories
Add
$5 First Class