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Please print out the order form, fill it out and fax it to us to place your order.

Ph: (61-2) 4784 1072 Fax:(61-2) 4784 2467

TAX INVOICE ABN: 37 404 240 346

 Receipt #:.......................  
Recipient:........................................................................ Delivery date:............... AM PM  
     
Delivery Address:    
N#...............  Street:...................................................... Suburb:................................................    
State:.................  Country:............................................ Postcode:..........   Ph:........................  
     
Order description:.......................................................... Card message:....................................  
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Payment method: (please tick)    
VISA Bankcard Mastercard AMEX    
Card #:_ _ _ _   _ _ _ _   _ _ _ _  _ _ _ _  Expiry:_ _ /_ _   
Name on credit card:........................................................     
     
Contact Details:  
Local delivery
 
Mt Victoria:
$15.00
Blackheath: $12.00
Medlow Bath: $10.00
Katoomba: $8.00
Leura: $6.00
Wentworth Falls : $8.00
Bullaburra: $9.00
Lawson: $11.00
Hazelbrook: $13.00
Woodford: $15.00
Linden: $17.00
Faulconbridge: $20.00
Springwood: $25.00
Hartley: $35.00
Valley Heights: $27.00
Warrimoo: $30.00
Blaxland: $35.00
 
Contact Name:................................................................ 
Contact Ph#:................................................................... 
Contact Fax#:................................................................. 
 
Order Summary: 
Order value:.................................................................... 
Delivery/Handling fee:...................................................... 
Total (includes GST):...................................................... 
 
 
 
Ph: 61 2 4784 1072 Fax:61 2 47842467 | email:lynda@leurablumes.com.au
Aspects of Leura Arcade, Shop 6/166 The Mall Leura NSW 2780
 
Items illustrated are for general guidance only. All prices quoted are inclusive of GST and in Australian dollars.
Variation in colour and types of flowers and/or containers may occur according to availability and/or season.