Brooks Entertainment Valentine Delivery Order Form

Use this form to send Brooks Entertainment's GROOVY DUDE to visit your sweetheart this Valentine's Day. Simply provide as much information as you can, then click the SUBMIT button. We will email you to confirm the details and, if paying by credit card, we will call you to get your card information. Thank you for your order!

Click here to access our regular order form. Click here to return to the Brooks Entertainment home page.

VALENTINE DELIVERY INFORMATION

Choose your Valentine Package

What song do you want the Groovy Dude to sing?

Delivery date (Feb. 13-15, 2012)

Delivery time desired

EARLIEST time delivery can be made

LATEST time delivery can be made (allow 1 hour minimum time span)

OK to deliver during lunch hour (typically 12-1 PM)? YesNo

Recipient Name (first and last):

Nickname

Additional recipients' names

Your personal message to the recepient

DELIVERY SITE

Please make sure that you have the correct address, including the right zip code and a contact number for someone at the delivery address.

Company Name

Building Name / Floor / Suite / Apt #

Delivery Street Address

City

State

Zip

Name of Contact Person at Delivery Site

Phone Number for Contact Person/Delivery Site (with area code)

Secondary Contact Person (in case primary contact person isn't available)

Phone Number for Secondary Contact Person(with area code)

Delivery Directions / Parking / Instructions

YOUR CONTACT and PAYMENT INFORMATION

Your Name (first and last)

Street Address

City

State

Zip

Email address

Daytime Phone (with area code)

Evening Phone (with area code)

Cell Phone (with area code)

Best PHONE number to reach you

Best TIME to reach you

Form of Payment

Payment details will be confirmed by phone. Visa and MasterCard, American Express and Discover accepted prior to delivery. Cash and personal checks made payable to Brooks Entertainment are collected at time of delivery.

Comments/Special Instructions

Thank you for your order! How did you learn about Brooks Entertainment?

Click on SUMMIT YOUR ORDER below. We'll contact you shortly to confirm details and finalize payment arrangements. If you don't hear from us within 24 hours, please contact us to make sure we received your order. Thank you!

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