Order Your Singing Valentine

Your Name
Relationship to Person receiving Valentine
Your Phone
Your E-mail	Please note a confirmation message will be sent to this email when your order is submitted

Enter your Singing Valentine Order Details


Person to receive Valentine:
Delivery Location:
Delivery Address:
Delivery City:	Zip/Area:
There is a $15 additional fee for delivery to this location. Also, we can not guarantee tight delivery time frames. We will contact you to advise.
On Site Contact: Same as above
On Site Phone: Same as above
Any Special Instructions:
Delivery Date:
Delivery Time Frame:
Preferred time range:	to: not guaranteed unless the 1 hour option is purchased
Select Your Order:
List Of Standard Messages:
Message for card to be delivered with song:
Order Total:
Payment By:	Check COD
	Please mail $40 check prior to February 10, 2012, or pay by cash or check at the time of delivery. Make checks payable to Orange Ridge Chapter-BHS, and mail to Richard Tardy, 4167 Aberdeen Lane, Lake Wales, FL 33859 Please make check payable to Orange Ridge Chapter-BHS and mail them to: Richard Tardy 4167 Aberdeen Lane Lake Wales, FL 33859
	Orders must be paid in cash or by check on delivery of the Singing Valentine
If you have questions, please contact the Singing Valentine coordinator at: rntardy@yahoo.com