Prom 2021 Order Form

Beverly’s Flowers and Gifts Email: Beverly@FlowersbyBeverly.com

Please place your order after your final dress selection All orders MUST be placed at least 3 days prior to the pick-up date. We do our best to accommodate everyone requests but substitutions may be necessary due to availability. To begin the ordering process, or for general inquiries, please fill out the form below. If you have any questions, stop by the shop or call 336.764.1091. Thanks for your order. This time can be very special so we ask that you enjoy and be safe.
Client Information
Name*
First Last
Cell Phone*
Home Phone*
Email*
Enter Email Confirm Email
Pick-Up Time

: HH

MM
Pick-Up Date*
School Name*
Are you ordering both a wrist corsage and boutonniere?*
2 Free loose roses if ordered at the same time to give to the mothers!
Order Details
Wrist Corsage - $39.95*
Price: $39.95 Quantity:
Boutonniere - $14.95*
Price: $14.95 Quantity:
Dress Color(s)*
Bracelet Preference*
Ribbon Preference*
Flower Color Preference*
“Bling” Preference*
Any Special Requests?
Designer’s Choice: Choose your colors and then let Beverly’s Staff work their Magic.*
Tux/Suit Color*
Tie Color*
Colors wish to Blend*
Pictures for Inspiration
Drop files here or

Accepted file types: jpg, png, pdf, jpeg.
If you have any pictures for inspiration, please upload them here.
Any Special Requests?
Subtotal
$0.00
For Grand Total, Please add 7% Sales Tax.

Client Information