Roberta's Plant Replacement Form

Name *
Prefix
First *
Last *
Suffix
Ph. # affliated with QVC account or # used when placing the original order. *

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Please Provide your full address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Email *
Order Number
Order Date

MM
/
DD
/
YYYY
Item Number
Name of Item *
How many plants do you need replaced? *
Colors needed within set
Choose the reason for replacement *
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