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Other please specify:



Occasion for Gift Basket
(Enter you basket selection here):
Select one Christmas Gift Baskets Valentine's Day Gift Baskets Hostess Gift Baskets Baby Gift Baskets Gourmet and Fruit Baskets Fragrance Gift Baskets Other

Other please specify:
(Enter other occasion here):

Greetings for Gift Basket:
(Enter greetings to be written in card here):

Choice of Gift Basket(s):
(Enter gift basket choice, price and any other instructions, allergies etc here):

Recipient's Name and Address:
(Please enter Recipient's full Name, Address and Phone Numbers here):

Check one:   Male   Female

Background:
Please provide any other helpful information here
(i.e child, teenager, retiree, etc):

Date required: (month/day/year)
01 02 03 04 05 06 07 08 09 10 11 12    01 02 03 04 05 06 07 08 09 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 2013 2014 2015 2016 2017 2018 2019 2020

Delivery Instructions:
(Special Delivery Instructions)

Sender's Name and Address:
(Please enter your full Name, Address and Phone Numbers here)

* Email Address:
(* required. Please enter your email address(s) here.)

Perk Code:
(Please enter your WORK PERKS Code here.)

Comments:
(Give us your feedback here)

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We reserve the right to substitute any product for others of equal or greater value.
Major credit cards accepted.

We will confirm your order by telephone within the next business day.
At that time we will confirm payment method as well as delivery instructions.
OR
If it is convenient after you have sent in your order form you can call us
right away with your credit card info and any special delivery instructions.

• Telephone: (613) 271-1134 •  Canada Toll Free: 1-877-322-0227 •