Order Form

NOTE: Only information marked * is Required (but other information will help).

1 ---- CUSTOMER INFORMATION - Please tell us a little information about yourself, so we can send you delivery confirmation

* Your First Name

* E-mail address

* Confirm E-mail address

* Your Country (Location)

Your Nationality

2 ---- DELIVERY INFORMATION

* Preferred Delivery Date

* Preferred Delivery Date :: Earliest possible Delivery Date is normally the DAY AFTER YOU SUCCESSFULLY PAY

NOTE: Delivery Today may not be possible. Delivery Tomorrow will probably be possible IF the time now in Thailand (see clock on left of this page) is before 6pm in the evening

* Preferred Delivery Time

* Preferred Delivery Time :: We will do our best to try to deliver in your preferred time period (but please understand we cannot guarantee this) - if the Recipient is available then

* (Probable) Delivery Place - Type

* (Probable) Delivery Place - Name

* (Probable) Delivery Place - Name :: Please make sure the place is within our delivery area - Pattaya, Naklua and Jomtien

(Probable) Delivery Address

(Probable) Delivery Address :: The address of the above Probable Delivery Place (please include Road and/or Soi Names)

Information we may need to find the Delivery Address

Information we may need to find the Delivery Address :: Please try to give us this (For example, a Google Maps link, driving directions)

3 ---- YOUR COMMUNICATION PREFERENCES (Optional)

Enter your own Mobile Phone Number (with Country Code, no spaces) if you want delivery confirmation by SMS text message (not available for Valentines, 10-14 Feb)

Enter your own Mobile Phone Number (with Country Code, no spaces) if you want delivery confirmation by SMS text message :: Do not include spaces.

Want us to try to do a Photo and send it to you after delivery, within 24 hours? (not available for Valentines, 10-14 Feb)

Want us to try to send you a Photo? :: We can e-mail a Photo to you within 24 hrs after delivery - if the recipient gives us permission to take a Photo

4 ---- RECIPIENT INFORMATION (Who to deliver to)

* Recipient (Short) First Name (Nickname)

* Recipient Contact Telephone Number (Mobile, if possible) (no spaces)

* Recipient Contact Telephone Number (Mobile, if possible) (no spaces) :: A telephone number (no spaces) we can use to contact them (or the place where they work, or the people they work or live with). Please make sure it is correct. If you cannot know the number, just enter 9999999

Recipient Full First Name (if possible)

Recipient Last Name (if possible)

* What To Do if we cannot contact Recipient?

* What To Do if we cannot contact Recipient? :: We will try to telephone Recipient before delivery, to check the place and time they can accept the delivery. Tell us what you want us to do if we cannot find the Recipient by the telephone number you have given us

5 ---- PERSONAL MESSAGE for Recipient (Optional)

To

Message

From

Want us to translate message into Thai?

6 ---- ANY OTHER SPECIAL INSTRUCTIONS (Optional)

Tell us anything else you want us to know/do

* Image Verification

* Image Verification :: Please enter the black text you see in the Image (case-sensitive), so we know you are human, not spam!

7 ---- PRODUCT INFORMATION - Please choose your product on the next page, by clicking on the button below ...

NOTE --- If you are still on this page, after clicking the "Send & Choose Product" button above ...... please look for error messages in red, next to the questions above

Roses-To-Pattaya