Note: To use the Request Form your browser MUST provide access to internet e-mail through  HTML forms.  If not, this request will not work, so instead, please call the Coordinator at 817-282-3312 or 817-689-7776.. (Be ready to provide the information requested below) or send an e-mail directly to Valentine Coordinator.  Your request will be handled as quickly as possible using the information you provide in this form.  You will be contacted via telephone to finalize and confirm this information.

STEP 1 -- 
CONTACT INFORMATION:

Your First and Last Name:
   So we know who you are.
Your Street Number Address:   Example: (1234 W. Main - Apt. 2A)
City:Example: (Fort Worth)
State:Example: (Texas)
Your Zip Code:   Example: (76132)
Your Telephone Number:Example: (817/123-4567)
Your Email Address:
 Optional contact via the internet.

STEP 2 -- 
Your Request for a VALENTINE gift to your special sweetheart Featuring one of our Texas Millionaires Quartets:

Here's the DEAL: 
For just $50.00 a barbershop quartet will deliver a special valentine to your sweetheart that includes 2 Valentine love songs, a silk rose and a valentine card at the requested location within the time windows specified below (Specific time at our discretion).  For this same service within a 2 hour window the charge is just $75.00; $100.00 for this same service provided at a specific designated time.

Select a delivery date:
  Friday February 12 -- 8:00 AM - 5:00 PM (Select delivery time below) 
  Saturday February 13 -- 4:00 PM - 9:00 PM (Select delivery time below) 
  Sunday February 14 -- Noon - 7:00 PM (Select delivery time below) 

Select a delivery option below: (All deliveries are for the date selected)
$50 -- (Delivered within the time windows specifed above-- Specific time at our discretion) 
$75 -- (2 hr. window within the time windows specifed above -- Include time in message window below)
$100 - (Specific time - Include time in message window below)
 

Preferred Payment: Cash Check  Charge
(Provide no Credit Card information on this form - wait until contacted via telephone) 

Provide delivery Information:
Who your Valentine is going to:
Example: (My Wife, Suzie Q. Jones)

Delivery Location Information:
(Address or other special instructions in space provided - Tarrant County area Preferred - Call for specifics or for delivery outside this area
Street Number Address:   Example: (1234 W. Main - Apt. 2A)
City:     Example: (Arlington)
Zip Code:    Example: (76101)

Emergency Telephone Number: (If we encounter a problem with delivery)
Example: (817/123-4567)
 

Message on the Valentine card for your loved one &/or Comments (Delivery time, instructions, etc.):

STEP 4 -- 
You may return to our Home Page
Be sure to Complete steps 1-3 First!

Note: If your are not contacted by us within a day to confirm your order information, please telephone our Valentine Coordinator at: 817-282-3312 or 817-689-7776 or e-mail Coordinator . 

(Thanks A Million!)