Customer Name: _________________________		

Address:       _________________________

	       _________________________

Phone Number:  _________________________


Please answer the following questions about the recipient of the basket.
Remember, the more information you give, the more personalized the basket will be.

1.  Male or Female?   _____________

2. What is his/her age?  ______________

3. Is this for a certain occasion? ______________________________________________

4. Any hobbies, sports fan, etc? ________________________________________________

5. Favorite colors or scents ? __________________________________________________

6. Favorite books or movies ? ___________________________________________________

7. Coffee or tea drinker?  ___________________________

8. Any allergies?  ______________________________________________________________

9. Things to avoid ? ____________________________________________________________

10. Special item (s) to include ? _______________________________________________

11. Additional comments / considerations? _______________________________________

_________________________________________________________________________________

12. Choose a price range.   (Some baskets cannot be done for the minimum price range.)

	$25 - $40		$40 - $75		$75 - $125		$125 +

13. Special message for recipient?  _____________________________________________

_________________________________________________________________________________

_________________________________________________________________________________


For office Use:

Order #: _____________

Promised delivery date: _____________________    Time: ____________________

Recipient Name: ___________________________

Delivery Address: _______________________________________________________