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Flowers for Shavuos order Form

Full Name*
First Name Last Name
E-mail*
Phone Number*

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

The price for a bouquet is $23.00. If you would like us to deliver it would be an additional $3.00.
How many bouquets would you like to order?*
Bouquet # 1 name
Bouquet # 1 address
Bouquet #1 message
Bouquet # 1* Please check one

Pick up on Tuesday, May 23, 5-6 pmDelivery to 14618,14610, 14620 only
Bouquet # 2 name
Bouquet # 2 address
Bouquet #2 message
Bouquet # 2* Please check one

Pick up on Tuesday, May 23, 5-6 pmDelivery to 14618,14610, 14620 only
Bouquet # 3 name
Bouquet # 3 address
Bouquet #3 message
Bouquet # 3* Please check one

Pick up on Tuesday, May 23, 5-6 pmDelivery to 14618,14610, 14620 only
Bouquet # 4 name
Bouquet # 4 address
Bouquet # 4 message
Bouquet # 4* Please check one

Pick up on Tuesday, May 23, 5-6 pmDelivery to 14618,14610, 14620 only
Optional Donation Towards The Flowers Project

$ USD
Total

$0.00 USD
Yes, I'd like to donate the cost of processing this transaction by adding 2.9%
Special Instructions

Payment

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