Name  _________________________________________________________________________


Address  _______________________________________________________________________

Phone Number   Day: _______________ Evening: __________________ Cell:_______________

How did you hear about AccentBaskets.com?

SBC Yellow Pages_______
Christian Yellow Pages ________
Online Yellow Pages ____________
Refer by other___________________
If you were referred by another person, please give name and address so we may send a "Thank you" gift.

What kind of Basket would you like to send?

Price Range: ________________________  Date you would like basket to arrive:_____________

Who would you like to send this gift to?___________________________________________________

Name:  _____________________________________________________________________________

Address: ____________________________________________________________________________

Their  telephone Number: (          )  _____________________________

Message on card: (remember to include who the basket is from) Include any special instructions:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Method of payment:

  Visa  ________      MC ________      AMEX ________      Discover  ___________    Check ________

Card#________________________________________  Exp Date:______________________________

7.75% CA State Sales Tax will be added to in State orders.

Card Holder's Name and Zip code:  _____________________________________________________

Deliver _______________________  Shipping:  Overnight  _____    2 Day _____   5 Day Ground _____  

Orders by fax will receive confirmation of your order.

Checks are accepted, however the check must clear before the order will be shipped or delivered. 

Please mail check payments to: Ac'cent Baskets. PO Box 3886 Mission Viejo, CA 92690

Occasionally, our suppliers experience temporary shortages.  We will always substitute equivalent
or superior products.  Quality and value are never sacrificed.

Thank you for your Order!