TO : Casket Gallery - URN Order Form (Fax # 619-265-3455)
FROM :
RE : Faxed Order



Order Form - Earthtone Brass Urn

Product Code - ugearthtone9575

Price - $199.99

The price quoted excludes applicable sales tax, & shipping charges.

Please Specify:
  Color
  Quantity  
  Commnents?:
 

Shipping Address:
  Name
  Address
  City, State, Zip:
  Is this a funeral home or a mortuary?


Please call Toll Free Nationwide Number
1-888-78-CASKET (1-888-782-2753) to
CONFIRM your order.
Thank you.

Buyer Information:
Title
First Name
Last Name
Email
Address
City
State
Country
Zip Code
Phone
Alt Phone
Fax
County
Shipping Options   Overnight delivery
2 day rush delivery
3 day rush delivery
Overnight Saturday
     delivery
Standard delivery

Deceased Person Information:
First Name
Last Name
 


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       Mastercard
Discover Card
Visa
American Express
Expiration Date      
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