Sweet Jane's Order Form



Sender's Information

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E-mail address:
First name:
Last name:
Phone Numbers:
 Day
 Night

Occasion

Recipient's Information

Name:
Address:
Phone Number:
Delivery Date:
  (Delivery charges will apply-based on location)
Age Category:
Special Request:
Product Preference:
Dietary Information:
Card Message:

Payment

Unfortunately we are unable to accept Visa Debit cards at this time.

Budget:
 $CAD (Plus HST)
Payment Method:
Credit Card Type:
Credit Card Number:
Expiration Date (mm/yy):
Credit Card CVV: 

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Sweet Jane's * 5431 Doyle Street * Halifax * Nova Scotia * B3J 1H9 * 902.425.0168

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