Poinsettia Order Form (2024)

Please fill out this form and click submit. All poinsettia orders must be received by noon on December 15. To order more than 4 poinsettias, please submit additional forms or contact the church office at 850-385-6441 or via email to graymumc@gmail.com.

Who is placing this order?

Name

*

Email

This address will receive a confirmation email

Phone (optional)

Poinsettias cost $10/plant and can be given in honor or in memory of anyone. Please provide the information as you would like to see it appear in the bulletin on December 22 and December 24.

Poinsettia #1

This is given:

*

Please select one option.

In honor of In memory of

Name of person(s) honored or remembered:

*

Poinsettia #2

This is given:

Please select one option.

In honor of In memory of

Name of person(s) honored or remembered:

Poinsettia #3

This is given:

Please select one option.

In honor of In memory of

Name of person(s) honored or remembered:

Poinsettia #4

This is given:

Please select one option.

In honor of In memory of

Name of person(s) honored or remembered:

Payment

Poinsettia #5

This is given:

Please select one option.

In honor of In memory of

Name of person(s) honored or remembered:

Payment Info

Poinsettias are $10 each. Please enter the total amount here and proceed with your payment information when prompted.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit. All poinsettia orders must be received by noon on December 15. To order more than 4 poinsettias, please submit additional forms or contact the church office at 850-385-6441 or via email to graymumc@gmail.com.

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