Billing Information
E-mail Address: 

First & Last Name: 

Address: 
              

City:    State:  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip Code: 

Phone Number: 
(Please include area code.)

How Did You Hear About Us: 

Please add my e-mail address to your mailing list:  Yes   No 

Delivery Information
Recipient's First & Last Name: 

Address: 
              
(We deliver to the Indianapolis area and surrounding counties only.)

City:    State:  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Zip Code: 

Directions to House from closest Major Intersection: 
(Include name of subdivision, if known.)

Where in the yard would you like the Yard Display set up? 

Is there anything in the yard or under the ground that we need to watch out for when setting up the Display? (Automatic sprinkler, outdoor lighting, etc.) No Yes 

Yard Display Information
Occasion:  Birthday  Other Special Occasion 

Type of Yard Display:  Flamingos (20) Smiley Faces (14) Hearts (20)

Delivery Date:  January February March April May June July August September October November December   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   2009

Greeting on Message Board:  (Approx. 10 characters per line, including spaces. Look here for message ideas.)
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Name(s) to include on Card for Recipient: 

Comments, Questions, or Special Requests: