Easter Lily Order Form
Given By
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In Memory / In Honor Of
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
Please select your easter lily.
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Easter Lily
Pink Lilies
$
8.00
Quantity
1
2
3
4
5
6
7
8
9
10
Easter Lily
White Lilies
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
1
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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