Poinsettia Order Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Select Your Color and Quantity
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Red Poinsettia
$
12.00
Quantity
1
2
3
4
5
6
7
8
9
10
Pink Poinsettia
$
12.00
Quantity
1
2
3
4
5
6
7
8
9
10
White Poinsettia
$
12.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Submit
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