​Love Is A Rose

Friendship and Memory Roses For Any Occasion
and especially for Mothers Day!

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

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

​Please proceed by following the instructions these instructions: 

• In the form at right (or below if using a cell phone), please fill in all blank spaces. You can use your "TAB" key to forward through the boxes or, your mouse pointer.
  
  
• 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 / Pay Pal 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. The form is best viewed in the landscape (sideways) position. 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. 

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.

► Report a Problem With This Form

     * = Fields that require a response

<a href="https://secure.blueoctane.net/forms/00U87RUYOJD1">Click Here To Load This Formexperts.com Form</a>