Please provide the following contact information:  (* required)

Name	*
Work Phone
Home Phone
FAX
E-mail	*

Size of Balloons:

Balloon Size

11-inch Please select size 16-inch 9-inch 5-inch

Mylar Size  18 inch heart Please select size 18 inch star 18 inch round

Color of Balloons: (Use the names of the colors found on the Qualatex site -- click here.)

Balloon Color

Mylar Color

Color of Ink 

Black, White, Red, Blue, Gray, Gold, Other

 

How many? (25, 50, 75, 100, 250, 500, 750+)

What kind of artwork/logo? (5- by 5-inch for 11-inch round balloons; 9 by 9 inch for Mylar balloons; also please specify Font Type (Block, Script, etc.)

Date Needed:

-- mm/dd/yyyy

Accessories

    Flower balloon weight  $0.75 each 

    Star balloon weight  $1.50 each

    Cups and ribbons (100pkg) $8.00

    Plain Latex Colored Balloons (100)  $13.00  

    Balloon Small Clips (100) $5.00

    Balloon Large Clips (50) $6.00  

    High Float 16oz with pump $10.00

    High Float 24oz $13.00

    Pump for High float 24oz $8.00

    Ribbon Navy Orange Purple Royal Silver White Red Green Black Gold Lime Light Blue Light Pink Peach Please select color      

Shipping Address:

	Shipping
Street Address	*
Address (cont.)
City	*
State/Province	*
Zip/Postal Code	*
Country

Shipping Method Preferred:

UPS
Priority Mail (USPS)

Method of Payment:

MasterCard (PayPal) Visa (PayPal)