This is a SECURE order form.
All transactions are protected using Netscape's Secure Socket Layers.

Please review the following ordering procedures:

• Telephone Orders: Please call us toll free at 1-888-BASKET5

• Offline Orders: For customers that feel uncomfortable sending credit card information over the internet you may print, fill out, and either Fax or Mail it back to us.

Basket Case
2524 W. Oakland Park Blvd • Fort Lauderdale, FL • 33311
Fax (954) 485-1579

• Online Orders: Please fill out the following order form so we can send your gift basket right away.

We can fill orders anywhere in the United States and Canada.

Full Name:
Address:
City:
State:	Zip:
Daytime Telephone	(Required)
Telephone:	(Required)
Fax:
Email:
Ship To:
Address:
City:
State:	Zip:
Shipping Address Telephone:

Special Instructions:

Home When:
Kind of Basket:
Occasion:
Special Requests:

Message on Card:

Prices

• We reserve the right to substitute items for equal or greater value depending on availability.
• All orders will be confirmed via telephone.
• Shipping charges are based on weight. You will be notified of your shipping charges when we confirm your order via telephone. Be sure to fill out the daytime telephone field above.
• All gift baskets are shrink wrapped with custom ribbons & bows cascading down the sides.

Basket Price: $
Tax (FL please add 6% tax): $
Shipping & Handling: $
Total : $

Payment Method

Choose payment method
			Check / MoneyOrder

*All Credit Card orders must be confirmed by email or phone.
Checks or M.O.'s can be mailed to the address below.

Name on Check or Charge:
Check #
Credit Card #
Expiration Date:	(MM/YY)