Elderberry Syrup Order Form
This order form is conveniently open 24/7, but the cut-off point for processing that week's orders to be picked up the following Thursday/Friday happens every Sunday at 10pm. We cook our fresh batches each Monday, and those orders are ready to go by that friday to ensure that your syrup and gummies are the freshest possible.
Regarding payment, I accept online forms of payment only so that the invoices can be paid prior to production and delivery. PAYMENT ON YOUR INVOICE IS DUE upon receipt for the following Thursday's/Friday's pick-ups. Please be prompt in paying your emailed invoice to ensure that your order will be a part of that week's production. If no payment has been received before closing out that week's orders Sunday, your order will NOT be cooked Monday. Contact us at (817) 513-0873 or
if you have ANY questions! Instructions for pick up will be listed below in section 2 of this form. Thank you for supporting our family's business, we TRULY appreciate you!
Are you a new or existing customer?
I am a new customer
I am an existing customer
Which item you would like to order?
16 oz Syrup-$36
8 oz syrup-$20
30 Count bag of chewable gummies-$25
How many of each would you like to order?
How do you prefer to pay?
Paypal "friends and family" (You will find my paypal link on the invoice I email you)
Credit Card through emailed invoice
Venmo (My venmo name is @Adrianne-Dorin)
Preferred Pick Up Location
Pick up in Aledo (West Ft. Worth/Aledo area)
Pick up at Heavenly Spines (Willow Park/Hudson Oaks/Weatherford area)
Pick up at Little Lilacs Wellness Collective (Hurst/NRH/Keller/HEB area)
Pick up in Benbrook (Central/South Ft. Worth/Mansfield/Arlington area) *address will be sent in the pick up reminder email*
Email address (invoices sent here)
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