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Ximena’s Bouquets
Eternal Rose Bouquet Order Form
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Pick Up Date & Time Needed by
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of
Rose Counts
12
14
18
22
25
30
36
40
50
Flower Color
White
Light Pink
Hot Pink
Red
Dark Red
Baby Blue
Royal Blue
Navy Blue
Yellow
Sage
Green
Purple
Lavender
Other
If you choose “other” what color would you like ?
Add Ons - Floral & Wrappings
Baby Breaths
Double Wrapping
Floral Mesh
Color you would like for either Double Wrapping or Floral Mesh?
Add Ons - Decor & Sparkle
Gold Butterflies
Silver Butterflies
LED Lights
Diamond Rhinestones
Pearl Rhinestones
Add Ons - Bows & Personal Messages
Pearl Bow
Ribbon Bow
Banner
If you would like a message, what would you like for it to say ?
Add Ons - Gifts & Extras
Plushies
Crown
Chocolates
Questions or Concerns
Type a question
Type option 1
Type option 2
Type option 3
Type option 4
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