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IMPORTANT: Please fill out form completely before final purchase
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PACKAGE TYPE: Deluxe, Standard or Mini
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POEM: A, B, C, D or E
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CERTIFICATE NAME-as you want it to appear on the Certificate (if applicable, include nickname)
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DATE OF BIRTH - DATE OF REST
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RECIPIENT- individual or family (i.e. Mrs. T. Jones, or Jones Family)
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RECIPIENT'S ADDRESS (This is 'where' you want the package to be sent)
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GIFT LETTER ENCLOSURE - yes or no. If yes, indicate name of sender
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PERSONAL MESSAGE OPTION (about deceased or condolences to individual or family)
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YOUR INFORMATION: Name, Address, Phone Number, Email address
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THANK YOU. Before we process your order, we will verify the information with you. Please understand that we will not be able to process the order until we receive your final approval. **PLEASE NOTE that PAYPAL will send you a confirmation of payment but will NOT confirm the Recipient's address & therefore may cause confusion with their "ship to" response to your payment. We will use the address of Recipient you provide to us on this form under 'RECIPIENT'S ADDRESS'
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