Simon Says Roses Florists

Flowers & Gifts Order Information Form

1) Please print & review this page. Our staff will require this information to quickly & accurately process your order. 2) Simon Says Roses...Never Closes. Please call now to our live, 24 hour phone lines at: Toll free: 1-800-705-ROSE(7673) in the U.S.A. & Canada
Item Order Code and Price Example: (D4-2977: $49.99) for a dozen long-stem roses. Add an 18" mylar balloon for $4.99. Add a 10" Teddy Bear or Belgian chocolates for $24.99.
Delivery Date
Recipient's Name
Recipient's Full Address (City, State, Zip Code, Address)
Recipient's Phone Numbers Day & Evening with Area Codes
Message & Signature (maximum 25 words. Custom greeting cards for longer messages are $3.99) Example: Happy Birthday, Mary. Love, John.
Your Name
Mailing address where your credit card bills are sent. (For your protection, we use address verification to make sure your card is not stolen)
Credit Card Type, Number, Expiry Date, and Full Name as it appears on the card.
Your EMAIL Address
Your FAX Number
Your confirmation number.

Toll-free 1-800-705-ROSE(7673) in the U.S. or Canada

or 1-250-391-4000 from other countries

Private information is protected and is kept strictly confidential.