Poinsettia Order Form
Deadline to order is Monday, December 5. Plants not picked up by Monday, December 26 will be taken to shut-ins on the morning of December 27.
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
In Memory Of:
In Honor Of:
Please:
Use my plant(s) for Christmas Eve. I will pick them up before Tuesday, December 27.
Use my my plant(s) for Christmas Eve and then take them to a shut-in.
My Products
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Red Poinsettia with Gold Foil
$
10.00
The 6” plants will have 6-7 blooms
Quantity
0
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9
10
White Poinsettia with Gold Foil
$
10.00
The 6” plants will have 6-7 blooms
Quantity
0
1
2
3
4
5
6
7
8
9
10
Pink Poinsettia with Gold Foil
$
10.00
The 6” plants will have 6-7 blooms
Quantity
0
1
2
3
4
5
6
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8
9
10
Processing Fee
$
1.00
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
SUBMIT
Should be Empty: