Poinsettia Set Up Form

Poinsettia Set Up Form
Please use this form to confirm your group is participating and schedule your preferred delivery/pickup date and time. Your group's final order with us will be on a seperate form when you are ready to order.
Organization's Name*
Enter access code from price list.*
Have you received this year's price and info sheet? (If not email sales@laysersflowers.com)*

YesNo

Schedule Your Flowers

Let's mark something down on our calendar. This can be adjusted anytime just let us know.
How do you want to receive your flowers?*

Deliver them (Free for orders over $300)Weekday scheduled pickup in MyerstownOpen pickup 9am-12pm Saturday December 13thOpen pickup 9am-12pm Saturday December 20th
If billing address if different that delivery address please contact us.

Local pickup customers: Please fill this in as your mailing address.
Delivery Place Name*
e.g. Jackson Elementary School (If house enter Residence)
Delivery Address*

Street Address

Street Address

CityState

Zip Code
Preferred Delivery Date and Time
Preferred Local Pickup Date and Time
Special Instructions (Optional)

Contact Information