Company Ship To:

c/o Name:

Address:

City: State: Zip Code:

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

Fax: Area Code - E-mail:

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How did you hear of our company?

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

- - - - - - - - - - - - - - Type Of Flowers - - - - - - Loose Flower Description - - - - - - - - - - - - - - - - - Total

Qty () X Choose One Plumeria Flower           $.20 each - 1,000 Up - Yellow Plumeria            = $

*Price on Loose Flower 1 to 999 $.40 each*

Each Box Is Packed With 1,000 Loose Flowers

- - - - - - - - - - - - - - Type Of Flowers - - - - - - Loose Flower Description - - - - - - - - - - - - - - - - - Total

Qty () X Choose One Plumeria Flower          $.40 each - 1 to 999 - Yellow Plumeria              = $

BOX CHARGE: MAINLAND - NEIGHBOR ISLAND - INTERNATIONAL

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

PACKING/HANDLING/AGRICULTURE USDA STAMP ($20.00 PER BOX)

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)

Important notice - Federal Express Charges $12.50 more per box for Saturday Delivery. You may wish to receive your shipment on Friday for that weekend. Shipping to any State east of the Colorado Mountains is two days delivery from Hawaii.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SUBTOTAL $

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - HI Tax 4.712%   $

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

Payment: Visa or Master Card accepted through LEIS OF HAWAII

Credit Cards Type: Choose One Visa MasterCard American Express Discover

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This Credit Card Will Not Be Valid Unless You Submit Your

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

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Exp. Date: 00/00

Name Of Person As It Appears On The Card:

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City: State: Zip Code:

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

Fax: Area Code - E-mail:

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.

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