2011 Poinsettia Sale to Benefit Hemophilia of Indiana

Order Form www.hoii.org

PLACE ORDER BY 11/28 12/5 12/12 Color Red Pink White Hanging Basket TOTAL ORDER Date of Order Delivery Date for order of 25 or more plants, in Greater Indianapolis (Check 1) November 30 December 7 Quantity DELIVERY/PICK UP DATE 11/30 12/7 12/14 Price Total $ $ $ $ $

December 14

Pick Up Date at Hemophilia of Indiana Office, 5172 E. 65th Street #105, Indianapolis IN 46220 (Check 1) November 30 December 7 December 14 Church/Business/Group Name Name (or Contact Person) Address (Mailing) Address (Delivery, if different) City Phone Email Cell Phone ZIP

Please send me an invoice Cash on Delivery (must be approved in advance) Check is Enclosed (payable to Hemophilia of Indiana) Credit Card (please circle): Visa, Mastercard, Discover, American Express Cardholder Name Account Number Signature Security Code Expiration Date

To Place Your Order Fax Email Toll Free Mail 317-570-0058 (Attn Poinsettia Order) mperigo@hoii.org 800-241-CURE Hemophilia of Indiana, Inc. 5172 E. 65th Street Suite 105 (note new address from 2010) Indianapolis IN 46220 Thank you and Happy Holidays!

2011 Poinsettia Sale A Benefit for Hemophilia of Indiana

Thank you for your support of Hemophilia of Indiana. Your poinsettia plant purchase contributes to the programs and services that Hemophilia of Indiana delivers to 1,200 Indiana residents and families who are impacted by hemophilia, von Willebrand disease and other bleeding disorders. Some of these services include Youth and Teen Camps Support Groups for Men, Women and the Spanish-speaking Emergency Financial Assistance MedicAlert Memberships Dental Insurance Annual Bleeding Disorders Conference Placement of Free Educational Materials in School Libraries Training For Teachers, Coaches, School Administrators, School Nurses and Purdue Extension Staff Information and Referral Advocacy POINSETTIA PLANTS Florist Quality Available In Red, Pink, and Whiiite Wh tte Wh e 5-7 Blooms per 6 Plastic Pot Wrapped in Red or Green Foil 16-18 in Height $10 per Plant for 25 or More (includes FREE DELIVERY in Greater Indianapolis $12 per plant for order less than 25 (must be picked up at Hemophilia of Indiana office) Delivery to Other Indiana Cities Available. Call 800-241-CURE for more information. HANGING BASKETS Florist Quality Available in Red Only 7 Plants in 8 Plastic Basket 24-28 in Diameter ORDERING AND DELIVERY SCHEDULE Delivery within Greater Indianapolis Only for Orders of 25 or More Plants. Call Toll Free 800-241-2873 to Ask about Delivery to Other Indiana Communities. Place Order November 28 December 5 December 12 Delivery/Pick Up Date(s) November 30 December 7 December 14

PAYMENT DUE ON DELIVERY/PICK UP (INVOICING AVAILABLE FOR COMMERCIAL ACCOUNTS) QUESTIONS? ContactMichael Perigo at 800-241-CURE toll free or mperigo@hoii.org