Name *

First Name

Last Name

Phone

(###)

###

####

Name of Performer *

First Name

Last Name

Performance Time *

12PM

6PM

Bouquet Selection *

Small - $35.00/$37.18 w/ tax

Medium - $50.00/$53.13 w/tax

Large - $65.00/$69.06 w/tax

X-Large - $80.00/$85.00 w/tax

Payment *

Venmo - @primroseruthfloral

Check - Primrose & Ruth Floral, 5 Birchwood Dr. Rehoboth, MA 02769