Christmas Blessing Baskets

Please fill out this form to order a Christmas Blessing Basket and click submit.

Name

*

Phone

*

Email

*

This address will receive a confirmation email

Payment

1 Basket ($25) 2 Baskets ($50) 3 Baskets ($75) 4 Baskets ($100) 5 Baskets ($125) 6 Baskets ($150) 7 Baskets ($175) 8 Baskets ($200) 9 Baskets ($225) 10 Baskets ($250)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form to order a Christmas Blessing Basket and click submit.

Please Fix the Following

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