Adopt a Tree or Wreath

Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com

Products

HALFWAY TO THE HOLIDAYS SPECIAL$125.00

Adopt a Tree & get a free wreath adoption

Quantity

ADOPT A WREATH$35.00

Quantity

ADOPT A TREE$125.00

Quantity

Total $0.00

Credit Card

ACKNOWLEDGEMENT FOR PLAQUE (Choose one then list name to go on plaque)
Name for Plaque
Example: The Smith Family; The Smith's; Sue & Joe Smith, etc
How did you hear about the Adopt a Lighted Tree or Wreath program?

Other
TO PAY BY CHECK, PLEASE PRINT THIS FORM AND MAIL TO:

Mainspring of Ephrata

16 East Main Street

Ephrata, PA 17522

Make check payable to Mainspring of Ephrata
Should be Empty: