Cemeterysales Standard Ordered Form

TO :	CEMETERYSALES.COM (Fax # 619-265-3455)
FROM :
RE :	Faxed Order

Order Form - Bronze - Memorial 10

Product Code - OGBRZ10

Price - 1199.00

The price quoted some colors may incur extra cost, please call to confirm your pricing 1-800-550-6325 from Cemetery Sales.

Price excludes applicable state sale tax, shipping, and Cemetery Installation charges.

Please Specify:

Product Number
Product Design
Size Description
Item# or Description
Quantity
Color
Font Options		Others
Background Texture:		Others

Pick Emblems (If Desired) and indicate placement in Special Instructions:
Category for Design Number
Emblem 1
Emblem 2
Emblem 3

Inscription:	Please fill in information showing what you want on their plaque or memorial.
Shipping Instructions:	Describe any urgency, anniverseries, special dates you are requesting for completion
Shipping Options:
Deadline for deliver
Date	(DD/MM/YY)
Time

Please fill in these boxes below:
Deceased Person Information:
First Name :		Second Name (If you need for a double one - Optional):
First Name		First Name
Middle Name		Middle Name
Last Name		Last Name
Date of Birth		Date of Birth
Date of Death		Date of Death
*Note: If all that is needed is one date just fill in the date of birth field.
Special Request (From Phone):

Buyer Information:

Title(Mr.,Mrs.,Ms.)
First Name
Last Name
Email (ex:name@hotmail.com)
Address
City
State	Zip Code
County
Phone
Alt Phone
Fax
Country
Relationship to the deceased.
Shipping Options
Shipping Options	Please select one (Overnight delivery,2 day rush delivery,3 day rush delivery,Overnight Saturday delivery, Standard delivery)
Cemetery/Shipping Address:
Name
Address
City, State, Zip:
Is this address a Cemetery/Funeral Home? (No,Yes)

Please call our toll free number
1-800-550-6325 to CONFIRM your order.

Thank you.
Cemeterysales.com

Method of Payment

Bill this order to:

Name as it appears on the card:

Billing Address

(Must be the billing address of the credit card)

Address line 2

City

State/Province

Zip Code

Card Number

Card Type (Visa,Master Card, American Express, Discover Card)

Expiration Date

(Month/Year)

CVV2

What is CVV2?(Click Here)

Select:

Please select one:
I have entered my CVV2 above
My card has no CVV2 imprint
My card's CVV2 is illegible

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I have read and I agree to the Terms and Conditions of Sale