la FLEUR d'HARLEM

✦ Artisanal Floral Atelier • Harlem • NYC ✦

Bespoke Floral Order Form

Custom arrangements, seasonal selections, and luxury floral gifting. Please provide your order specifications below.

Orders directly route to: fleur@lafleurnyc.com

1

Customer Information

Details of the person placing the order

Full Name *

Email Address *

Primary Phone *

Alternate Phone 1 (Optional)

Alternate Phone 2 (Optional)

2

Recipient & Delivery Destination

Where our courier will deliver your handcrafted blooms

Recipient Full Name *

Street Address *

Apartment, Suite, Unit, PH (Optional)

City *

State *

Zip Code *

Country *

Recipient Primary Phone *

Delivery / Gate / Concierge Notes (Optional)

3

Order Details & Floral Preferences

Date, occasion, budget tier, and custom card message

Requested Delivery Date *

Preferred Delivery Window * Select delivery window Morning (9:00 AM – 1:00 PM) Afternoon (1:00 PM – 5:00 PM) Evening (5:00 PM – 7:30 PM) Flexible / Anytime Studio Hours

Occasion / Theme * Select an occasion Birthday Anniversary Romantic / Just Because Sympathy & Condolences Thank You Get Well Soon Corporate / Event Other Bespoke Request

Flower Budget ($ USD) *

$

Custom luxury arrangements start at $85

Arrangement Budget: $200.00

NYC Courier Delivery: $28.00

NYC Sales Tax (8.875%): $20.24

Estimated Total: $248.24

Arrangement Style, Flower & Color Preferences *

Enclosure Card Message * 0 / 300 characters

Payment & Confirmation Security Notice

Payment information is never gathered via unencrypted web forms. Once submitted, our floral studio will review bloom availability and send a secure invoice link or call directly to finalize payment.

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