First Name
Last Name
Email
Phone
(input 1, area code and number, no spaces or dashes)
Street Address:
City
State
Zip
Lily
Plants
Number of Lily Plants:
Lilies Total:
$
Gifted Lily Plants
Number of Gifted Lilies:
Gifted Lily Cost:
$
Deliver Gifted Lilies to (include Name, Phone Number and Address of Recipient:
Gifted Lily Total:
$
Donate Lily Plants
Number of Donated Lilies:
Donated Lily Cost:
$
Donate Lilies To:
Please select...
Domestic Violence Program
Kitty Askins
Community Soup Kitchen
First Responders
Donated Lily Total:
$
Bow
Would you like to add a purple bow to your lily? $2.50 per plant.
Bow Total:
$
Will you add 3% to this purchase to help cover our online expenses and processing?
Yes
Pick Up or Delivery?
Pick Up
Delivery
Total Due:
$
Click
Submit
to Pay with PayPal, then click the Yellow PayPal button on the next screen.
If you are paying at Pickup, please check the
Pay at Pickup
checkbox, then click
Submit:
Pay at Pick Up
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