House Plant Delivery Form
Plants
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( X )
Succulent
$
8.00
Quantity
0
1
2
3
4
5
String of Pearls
$
6.00
Quantity
0
1
2
3
4
5
Snake Plant
$
6.00
Quantity
0
1
2
3
4
5
Rubber Plant
$
8.00
Quantity
0
1
2
3
4
5
Peace Lily
$
10.00
Quantity
0
1
2
3
4
5
Potting Soil
$
5.00
Quantity
0
1
2
3
4
5
Name
First Name
Last Name
Email
example@example.com
Phone Number
Delivery Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Payment Methods
Debit or Credit Card
1
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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