Altar Flowers

YOUR INFORMATION

Your Name

First Name

Last Name

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

FLOWER & DEDICATION DETAILS

Flowers Are Given By

In Honor or Memory Of?

In Memory Of

If you are dedicating flowers in memory of a loved one (or ones), please list their name(s) below.

In Honor Of

If you are dedicating flowers in honor of a loved one (or ones), please list their name(s) below.

Dedication Message

Due to limited space in our bulletin, we ask that you please keep the dedication message to ___ words or below.

Details for Florist

Please list flowers you wish to include or exclude, including colors or design requests. All notes will be delivered to the florist for preparation, however, we cannot guarantee all requests will be fulfilled.

Donation Amount

Please list how much you wish to donate. a) single donor - minimum $125; b) two donors - minimum amount $75.00

Preferred Date for Flowers

MM

DD

YYYY

Additional Date(s) for Flowers

We will try to honor your preferred date. However, if that date is not available, please list alternate dates or months that also work.

Flower Pickup

Other Notes

If you have any other specific requests or questions for Teresa Robertson, please list them below.