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    Do not use special characters. Alpha or Numeric for SSN and GST one box per role.


    * = required field.


    *Teleflora ID:
    *Shop Name:
    *Address 1:
    Address 2:
    *City:
    *State/Province:
    *Zip/Postal Code:
    *Country:
    *SSN1:
    SSN2:
    SSN3:
    POS Types:
    Daisy
    Eagle
    RTI
    Dove POS
    Services:
    24 hour flower service
    Credit Card
    Dove Network
    eFlorist Service Center
    FindAFlorist Web Statistics
    Email
    FTD Member
    Participating in Coop Ad
    Participating in Dove Plus
    Plus Mail
    eDelivery
Teleflora ID:
Teleflora ID:
Email: