Pinwheel Form

Pinwheel Garden / Personal Pinwheel Garden

Please fill in the form below.
Full Name *

Prefix First Name Last Name

Delivery Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
E-mail
Start Date preference (if any)
00/00/0000
Type of Pinwheel Requested *
Pinwheel Slection

Pinwheel Garden $ 50.00

Quantity

Personal Pinwheel $ 25.00

Quantity

Total $ 0.00
Payment Method:

- Make check payable to Exchange Club Family Support Center

- Credit/Debit Payments:

Can be made in person at the Center - 8320 Iowa Street, Downey, CA 90241 or

Online via our website www.DowneyFamilySupport.com “DONATE” button or

through the Exchange Club Family Support Center Facebook page

For questions, please call the Center at 562-904-9590

THANK YOU FOR BEING A PART OF THIS EFFORT TO SHOW YOU CARE.

YOU MAKE A DIFFERENCE!!
Questions or comments
Enter the message as it's shown *
Should be Empty: