Seed Packs Request Form

Ayrshire Baby Loss Support

Seed Pack Request Form
We have two different seed packs available, both contain wildflower seeds suitable for planting in window pots and gardens. Each pack has one of the two poems shown below printed on the front, please choose which seed pack/s you would like.

Please note by completing this form you are agreeing to us holding your personal information for the purpose stated. This information will be held securely and will only be used for the said purpose.
How to order Seed Packs

1. Please make sure check box is ticked for which pack/s you require.

2. Select amount you would like from dropdown box.

3. Fill in the details of where to send the seed pack/s.
Name

PrefixFirst NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
Please provide an Email address for confirmation of your order.
example@example.com
Any other details you would like us to know
Seed Pack order form
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Poem 'A little flower...'
This pack is printed with:

A little flower

lent not given

To bud on earth

and bloom in heaven

Free Quantity

Poem 'A fragile flower...'
This pack is printed with:

A fragile flower,

small and true.

Forever part of morning's due.

In these blooms,

I find you near,

A bittle sweet eternal tear.

Free Quantity

Total

£0.00
Should be Empty:

Ayrshire Baby Loss Support