Love
Lights
(Quantity)
Keepsake
Ornament
(Quantity)
In
Honor
of:
In
Memory
of:
Name(s)
 
 
 
Total Number of Lights:
Light Cost ($5.00/ea): $
Total Number of Ornaments:
Ornament Cost ($15.00/ea): $
Order Total: $

Payment Information:
Name: Phone Number:
Address: City, State, Zip:

Payment Information
Card Holder Name:
 

Card Number:
 

Expiration Date:
/
 

CCV Code:
 

Credit Card Logos