Order Form

Let one of our flower experts design something special for you.

Please Note:

Prices do not include HST (tax) or delivery charges.

Valley Rose Flower Shop will contact you with the final details of your order

Please also remember to copy & paste your order number for your arrangement in the order form.

If you have any questions regarding any arrangement on this site, please do not hesitate to contact us.

ORDER FORM

Choose Occasion
Color preference
Order Number (enter order # of your arrangement)
Price
Options
Boxed Chocolates - $10
Boxed Chocolates - $15
Boxed Chocolates - $20
Stuffed Bear - $10
Stuffed Bear - $15
Stuffed Bear - $25
Mylar Ballon - $6.98
Full Size Card - $4.00
3 Piece Bath Bomb Set - $10.00
Card Message
Delivery Date

Recipient's Information

Recipient's full name
Recipient's address
Recipient's town/village
Recipient's postal code
Recipient's phone number

Sender's Information

Senders's full name
Senders's address
Senders's town/village
Senders's postal code
Senders's phone number

Payment Information

Name on credit card
Credit card number
Type of Card (Visa / MasterCard)
Expiry Date
Other comments / instructions

Authorized Teleflora Florists

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Delivery Areas:

  • Aylesford
  • Nictaux
  • Margaretsville
  • Middleton
  • Greenwood
  • Bridgetown
  • Paradise
  • Wilmot
  • Lawrenctown
  • Kingston
  • Berwick
  • all areas in between...