General Info: * required info

*Sender's Name:

*Phone #:

*Second Phone #:

*Email:




*Recipient's Name:

*Phone #:

Second Phone #:

Email:

*Address:

Optional location if recipient is out:


Item Description:                   


Plant Type:
   Quantity:
Special instructions and additional items:



Delivery:                                 

If you live within the lower mainland please fill out this part:
Delivered?:
Pick Up?:

Delivery Date:
Regular Thursday other date

Note: Cut off time for Thursday deliveries is Tuesday at 11 a.m. Arrangements can be
made for other days. We will confirm with you at time of payment.

Special Instructions for delivery:



Message:                                

Standard message card?: Yes No
Kermodi Garden Art card?: Yes No

Message:


Would you like to be on the Kermodi mailing list?: Yes No

We will contact you via phone or email to confirm your order, handle any special requests, and to process payment.

Thank you for using Kermodi!











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