Please provide the following contact information:  (* required)

Name	*
Work Phone
Home Phone
FAX
E-mail	*

Size of Balloons:

Balloon Size

11-inch 260 16-inch 9-inch 5-inch Hearts

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

Balloon Color

Color of Ink:

Black, White, Red, Blue, Silver, Gold, Other

Black Gold Green Silver Yellow White Red Blue Other

Brand of Balloons:

Qualatex,  Betallic

Qualatex Prestige Betallic

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

What kind of artwork/logo? (5- by 5-inch for 11-inch round balloons; 1- by 16-inch for 260 long balloons; also please specify Font Type (Block, Script, etc.)

Date Needed:

-- mm/dd/yyyy

Accessories

        Flower balloon weight  $0.75 each 

        Star balloon weight  $1.00 each

Other special Balloons

Qty

Disney Princess Balloons (6pk)

Shrek Balloons (6pk)

Shrek Punch Ball (1)

Turtles Balloons (6pk)

Turtle Punch Ball (1)

Spiderman Balloons (6pk)

Spiderman Punch Ball (1)

Winnie the Pooh Balloon (6pk)

 

Shipping Address:

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

Shipping Method Preferred:

UPS
Priority Mail (USPS)
FedEx

Method of Payment:

Invoice Check MasterCard (PayPal) Visa (PayPal)