LEIS OF HAWAII

VALENTINE'S DAY

ORDER FORM

Date Ordered: Date of Delivery:

PLEASE CHECK ONE - SHIPPING TO BUSINESS - SHIPPING TO RESIDENCE

Company Ship To:

c/o Name:

Address:

City: State: Zip Code:

Phone: Area Code - Ext: 1-800 or 888: -

Fax: Area Code - E-mail:

Contact Name:

How did you hear of our company?

*VALENTINE'S LEI*

Includes Any One Lei, Tax & Shipping.

$100.00 Total

Choose From One Of Our (6) Flower Leis

- - - - - - - - - - - - - - - Type Of Leis - - - - - - - - - - - Lei Description - - - - - - - - - - - - - Total

Qty () X = $


Tuberose / Red Rose	Tuberose	Tuberose / Lantern Ilima	Micronesian Ginger / Red Tip	Micronesian	Christina Orchid Feather

Or Select From These Leis Below

*VALENTINE'S LEI*

Includes Any One Lei, Tax & Shipping.

$150.00 Total

Choose From One Of Our (3) Flower Leis

- - - - - - - - - - - - - - - Type Of Leis - - - - - - - - - - Lei Description - - - - - - - - - - - - - Total

Qty () X = $


Centipede	Sweet Darling	Honey

Or Select From These Specialty Items Below

*VALENTINE'S SPECIALTY*

Choose From One Of Our (3) Specialty Items

Tax & Shipping Not Included

(Money Lei Payment Must Be Made Prior To Shipping)

Please Allow Time For Outer State Checks, Cashier Cash or Money Orders

Feather Rose

Money Lei

Money Rose

Name To:

Add Personalized Message To Card:

BOX CHARGE: MAINLAND - NEIGHBOR ISLAND - INTERNATIONAL

Qty () - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - $

PACKING/HANDLING/AGRICULTURE USDA STAMP (INCLUDED)

Important notice - Placing last minute orders to be shipped the same day is subject to a surcharge fee of $20.00 Airbill.

SAME DAY SERVICE ORDER ($20.00)

Valentine's Day February 14th. Falls On A Wednesday.

Important notice for shipping schedule:

Over Night Delivery: Going West of the Colorado Mountains.

Shipping Date: February 13th ~ Monday - Shipment from Hawaii to the Colorado Mountains For Arrival Tuesday the 14th between 9:00 a.m. and 12:00 noon needs to go out this day.

Include States: WA, OR, CA, ID, UT, AZ, CO

2 Days Delivery: Going East of the Colorado Mountains.

Shipping Date: February 13th ~ Friday - Shipment going from Hawaii to the East of the Colorado Mountains is 2 days delivery and is needed to go out this day For Arrival Wednesday the 15th between 9:00 a.m. and 12:00 noon. (IF YOU WISH TO SHIP OVER THE WEEKEND ~ PLEASE CALL IN YOUR RESERVATION ~ 1-888-534-7644)

Include States: AK, MT, WY, CO, NM, ND, SD, NE, KS, OK, TX, MN, IA, NO, AR, LA, WI, IL, KY, TN, NM, IN, AL, MI, OH, GA, WE, NY, PA, WV, VA, NC, SC, FL, VT, NH, ME, MA, RI, CT, NJ, DE, MD, DC

*Federal Express Included*

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TOTAL DUE $

Payment: Visa or Master Card accepted through LEIS OF HAWAII

Credit Cards Type:

Card No:

This Credit Card Will Not Be Valid Unless You Submit Your

Last 3 Digit Numbers Located On The Back Of Your Credit Card:

Exp. Date: 00/00

Name Of Person As It Appears On The Card:

Credit Card Billing Address:

City: State: Zip Code:

Phone: Area Code - Ext: 1-800 or 888: -

Fax: Area Code - E-mail:

AVS (Address Verification Service

When complete, click "submit" to email Leis Of Hawaii. If you wish to have a hard copy of your order, please print "Form Confirmation" page after submitting. Please allow processing time. You will be contacted by your email below once your Credit Card has been approved, which will confirm your order. You will be contacted by your email if there is any problem with your order.