Raider Floral & Events Order Form

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REQUESTOR'S INFORMATION

*Requestor Name:

Please enter first and last name.

*Date and Time of Request

*Email Address:

*Phone Number:

Department:

FOP #.

ITEMS TO ORDER

*Stock Number

Please Select #6503785 - 6" SPATH #4715143 - 6" POTHOS #8118588 - 8" POTHOS #4506846 - 10" DRACENA #5486676 - Employee Appreciation Candy Arrangement (Feb/Mar seasonal purchase only) #4050038 - Mother's Day Arrangement (Apr/May seasonal purchase only) #0042150 - Christmas Poinsettia 6.5" (Nov seasonal purchase only) #4182067 - Christmas Poinsettia 8" (Nov seasonal purchase only) #0277550 - Valentines Candy Arrangement (Jan/Feb seasonal purchase only) #7707640 - Valentines Floral Arrangement (Jan/Feb seasonal purchase only)

Quantity:

Please add the quantity of the product here:

DELIVERY INFORMATION

*Recipient's Name

Please enter first and last name.

*Date of Delivery

*Location of Delivery

Please Select On Campus (free delivery during weekday business hours) $10 for delivery inside the Loop 289 $20 for delivery outside of the Loop 289 (maximum 20 miles) $30 for delivery outside of Lubbock city limits

On Campus: Building Name and Room

Off Campus Delivery Address:

Name of Receiver, Number and Street Name, City, Zip

Comments/Special Requests:

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