Flower Order Form 🌸

Fleurbana🪻 - Luxury Floral Arrangements

📍Located in Baltimore County, MD. Middle River. Local delivery available for an extra charge. Please order a week before desired date. After you place your order here you will receive a link via email and text message to pay the deposit. The non-refundable 50% deposit is required to secure your order. The deposit is included in final price, balance is due in cash at pickup/drop-off. Once paid Please wait 24 - 48 hours for confirmation email/text. *If you’re doing a pickup the address of location will be sent the day before pickup day.* Thank you! 🩷
Pick- up & Delivery range from...

Monday : 9:00AM - 1:00PM

Tuesday : 9:00AM - 1:00PM

Wednesday : 9:00AM - 1:00PM

Thursday : 9:00AM - 1:00PM

Friday : 9:00AM - 1:00PM

Saturday : 9:00AM - 1:00PM

Sunday : 9:00AM - 1:00PM
Your Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Delivery Date

MonthDayYear
Date
Pickup or Delivery?
Delivery Address (Only fill if you’re getting order delivered)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Special Instructions (optional)
Mixed Wrapped Bouquets

Ideal for celebrations, birthdays, etc..
Bouquet Size?
What flowers do you want included in the bouquet?
Wrapping paper color?
Ribbon color?
Vase Bouquet

Ideal for mother’s days, centerpieces, etc.
Bouquet Size?
What flowers do you want included in the bouquet?
Vase Color? (Shape may vary)
Potted Floral Arrangement

Ideal for mother’s days, centerpieces, etc.
Bouquet Size?
What flowers do you want included in the bouquet?
Pot Color? (Shape may vary)
Ikebana inspired Floral Arrangements

Luxury show stopper floral designs! - Ideal for weddings, centerpieces, etc.
Arrangements Size?
What flowers do you want included in the bouquet?
Dish Color? (Shape may vary)
Want to add to include a note? Type below what you want to say on it!💌
Inspo Photo?⬇️💐

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Any Special Request? - (will try my best to fulfill, we be communicated if not possible. Thank you for understanding.)
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Fleurbana🪻 - Luxury Floral Arrangements