​Love Is A Rose
Friendship & Memory Roses For Any Occasion
Thank you for selecting our Love Is A Rose online purchase option.
For additional Information, please contact: Sandy Campuzano ► svcampuzano@gmail.com ​

Your donation is Tax Deductible; the Kansas City Rose Society is a 501 (c) (3) organization.

​Please proceed by following these instructions: 
  • In the form at right (or below if using a cell phone), please fill in all blank spaces.

  • When typing, please do NOT use all UPPER CASE LETTERS; use capital letters only where appropriate. 

  • Once you have completed the form to your satisfaction, click the SUBMIT button. You will then be taken to our credit card page where you can complete your application.

  • Note, that if you begin filling in the blanks on this page, and then visit another web page before completion, that you could risk loosing the data you have already provided.  Be prepared before you begin.​
*Perpetual bed donation must be purchased
by hard copy form only!
NOTE: If using a "cell phone" to fill out this form...  Before filling out the form, scroll down to see if you can see the Submit button; if not, turn your phone sideways.  You can also use your finger to move the content Left to Right.

NOTE: If you are using a computer at your "work place" to fill out the form, know that some office computer security systems and firewalls might not allow you to submit the form. If you try and cannot, then you must use a computer outside of your work place.
If using your "auto fill" feature to populate the name and address fields below, please make sure the fields fill properly.

* = Fields that require a response

NOTE: If, on form submission, you get a RED screen... go back and review; you have inadvertently failed to provide a response in a "required" field.

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