logo logo 2008 Flower Order Information Form

 

Everyone loves receiving flowers! We are able to offer this value once a year, so please take this opportunity to surprise as many people as you can. Your flower order will be delivered on Monday, April 21. Our supplier guarantees these flowers for three days after delivery. If there is a problem, call 669-0198 by noon on April 24 for free replacement flowers.

How to Order

There are two easy ways to order:

1. You can download and print an order form by clicking on the following link:

PDF Order Form

Print the form, fill out, and mail with check no later than April 15:

Mail Your check payable to:

MCLC Lions Rose Day
c/o Lion Melissa Novinski
905 N Division Street
Waunakee, WI 53597

2. Or use our On-Line Order Form below to order.

Flower Information: (amount required)

Mixed Flower Bouquet @ $18.00 each

Dozen Red Roses @ $24.00 each

Dozen Mixed Color Roses @ $24.00 each

Glass Vase @ $4.00 each

Buyer Information: (* required)

* Buyer Name:

* Buyer eMail:

* Buyer Phone:

* Buyer Address:

Comments:

Delivery Information:

*Deliver to:

Company/Home:

* Street Address:

Suite/Apt #:

*City:

* Zip Code:

* Recipients Phone:

Special message to recipient:

Special
Delivery
Instructions

Payment Information:

Method of Payment:

I will mail a check (as detailed above).
I will submit credit card information below.

Credit Card Information: (NOTE: Please enter credit card billing address in the Purchaser address above.)

Credit Card #:

(numbers only, no dashes)

Expiration Date:

(numbers only, no dashes)

CSV Code:

(numbers only, no dashes) (last 3 digits on back of card by the signature):