Order Form

Roses Pre-Order Form Place order before 7th February 2011, to get a cheaper price!

Name *

Contact no: *

Email *

Order Details Please fill in your order as below:

No. of Roses *

7 roses - RM 80   11 roses - RM100   15 roses - RM150   21 roses - RM180   36 roses - RM270   99 roses - RM550   100 roses - RM 555  108 roses - RM600  Please choose the no. of roses you want to gift

Color of Roses *

Red   Dark Pink   Light Pink   Yellow   White   Purple ** need to order before 31/1 **   Blue **need to order before 31/1 **  Please choose the color of roses you want.

Add on Chocolate *

RM10 per box (small - 4 chocolates with nice packaging)   RM20 per box (big - 8 chocolates with nice packaging)   No Thanks  Would you like to add on chocolate?

Delivery Method *

Direct deliver to receiver -- RM 20   Pick up at Kuchai Lama, KL -- FREE  Pick Up will not be charged for delivery fees.

Pick Up / Delivery by:

** eg: 14 Feb, 11am delivery service is only provided on 14th Feb (from 10am to 9pm) pick up is available from 11/2 to 14/2 (from 10am to 9pm)

Payment Method *

Bank in (Maybank: 114-124-026-725 YEONG KAR WAI)   Paypal (email: stella_karmun@hotmail.com)

Receiver Details If you need us to deliver for you, please fill in the form as below:

Receiver's Name

Receiver's Contact no

Receiver's Address

<br /> Fill up the full address. Delivery service is only provided for area within Kuala Lumpur and Selangor.

Greeting Message:

<br /> Drop down the message if you want to say to the receiver. .

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