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Online Order

When you wish to order an item for delivery, you will just have to fill out this online form with your name and the recipient's information. Your order will be processed directly from the Hypnotic Bloom store rather than over the internet. Hypnotic Bloom will contact you directly for your credit card number.

Initially, we require that you fill out the profile form below with your credit card and contact information, which is then kept on file at Hypnotic Bloom.

Order Form

Name of Bouquet *
Quantity *
Sender's Name *
Sender's E-Mail Address *
Sender's Daytime Phone Number: *
Recipient's Name *
Credit Card
Experation Date:
Recipient's Daytime Phone Number:
Recipient's Evening Phone Number:
Delivery Address *
City *
Province *
Postal Code *
Delivery Date *
Card Message *
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