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Beloit Wis. 53511
Email Us at:
"Order Form for Flowers"
DELIVER TO:
ADDRESS:
CITY:
STATE:
PRESENT THE ABOVE COMPLIMENTS OF:
YOUR NAME:
YOUR PHONE:
Enclosed is my check in the amount of $:
PHONE:
Qty: Dozen
OR Payment by
Credit Card:
Fill out the upper part of this form then print it out and send with your check to:Beloit Noon Lions 2762 S. Hart Road Beloit WI. 53511 or Purchase on line by clicking on the "Buy Now" button at the bottom of the form
$18.00 Per Order
Your choice of 1 Dozen Roses
or 2 Dozen Carnations for only
or 2 Dozen Carnations for only
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Qty: 2Dozen
ROSES
CARNATIONS
ADD DIRECTION TO LOCATION IN BOX BELOW IF NEEDED:
YOUR E-MAIL ADDRESS:
Notice!!
After entering your credit card information, be sure to add the recipients name and address in the special instruction box
After entering your credit card information, be sure to add the recipients name and address in the special instruction box