Christmas Poinsettia Order Form

Name

(Your name will appear as the one giving the flowers)

First Name

Last Name

Email and/or phone number

In case we need to contact you

In Honor/Memory of

(example) My parents, Jack and Suzanne Persons and other loved ones

# of Poinsettia Plants ordered

(6.5 inch pot - 1 plant/pot)

In lieu of flowers (or in addition to my flower order) I would like to make a donation to the Building Fund

$

Total amount

$

Send your check to:

Emmanuel Reformed Church 1150 Maple Hill Road Castleton, NY 12033

Check the box as appropriate

I will pick up my flowers after worship December 24 or later