Pup-o-Gram Delivery Detail Form

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2023 Valentine Pup-o-Grams delivery details form!

Please be sure to complete this form before or after making your payment for a Pup-o-Gram.

Payments can be made in person at the Shelter, using a card online through the HSIC online shop, or using any method listed on the HSIC Donation page.

Thank you so much for supporting the Humane Society of Independence County and happy Valentine's day!

Name *

Email *

Phone Number *

Pup-o-Gram Type *

Package A $25 - Your Valentine CARD will be delivered with a customized message by a puppy with a valentine bow. (snuggles included).

Package B $50 - Your Valentine card AND CANDY will be delivered with a customized message by a puppy with a valentine bow. (snuggles included).

Package C $75 - Your Valentine card, candy, and 3 flowers will be delivered with a customized message by a puppy with a valentine bow. (snuggles included).

Package D $100 - Your Valentine card, candy, AND 3 ROSES will be delivered with a customized message by a puppy with a valentine bow. (snuggles included).

Person Receiving Valentine Gift *

Address for Delivery *

Phone Number of Delivery *

Customized Message for Delivery *

Preferred Method of Payment *

Cash, Card, or Check at Shelter

Credit Card - Online HSIC Shop

Cashapp - Include name and "valentine" in memo line

Paypal - Include name and "valentine" in memo line

Venmo - Include name and "valentine" in memo line

Other:

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