If you are interested in setting up an account please fill out the application form.  If you do
not fill out the form completely, it will delay the approval process.  It can take up to 7 working
days to receive your Account number.  Please be patient.  

Thank you.
Personal Account Application Form
Contact person for
this application:
Full Names of Persons
Authorized to use this
account:
Email:
HomeAddress:
Home Phone
Number:
Mobile Phone
Number:
Cardholder's
Name on card:
Check method
of payment:
 VISA
 MASTER
CARD
 AMERICAN
EXPRESS
 DISCOVER
credit card
number:
4 digit Credit Card
Expiration Date:
 CV2-code number on back of card (3 digits)
AMEX 4 digit security code:
Billing Address of Credit Card-
Numbers Only:
Billing Zip Code of Credit Card:
*Declaration:  Are you the card holder on
the credit card?
YES
 NO
Questions, comments, or feedback:
NINFA'S FLOWERS & GIFTS
2405 WHITTIER BLVD.
LOS ANGELES, CA. 90023
(323) 262-9238
ninfasflowersngifts@yahoo.com