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Order Form

Fields Marked * are required.

All prices have been quoted in Canadian dollars. If your order is being delivered outside Canada the daily exchange rate will apply.

Please be advised that a delivery charge of $12.00 will be applied in the Victoria area and appropriate taxes will be added to your order.

* Required Field

You Ordered:

Coastal Treasures Basket for $70.00

Sender Information

* Name
* Phone Number
Email
* Basket Type
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Changes

If you would like to omit something from your basket or substitute/add an item, you may
substitute more of another item or ask for an addition not currently included.
Changes may effect final price.

Changes (please specify)

Delivery Information

* Street Address
* Deliver to:
* City
* Province/State
Postal Code/ZIP
* Phone Number of Recipient (required for delivery)
Country
* Delivery Date
Card Message
* Credit Card Type
* Credit Card Number
* Expiry Date
* Three or four digit security code from back of credit card

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