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Professional Grave Tending by Always Remember

ORDER FORM

YOUR NAME:____________________________________

ADDRESS:_______________________________________________________________________________________

PHONE:( )_________________________________

LOVED ONE’S NAME:____________________________________________________________________________

DATE OF DEATH:________________________________

CEMETERY:_____________________________________

CITY OF CEMETERY:_____________________________

SECTION & LOT NUMBER (if available):______________________________________________________________

PACKAGE REQUESTED: Gold ___ Silver ___ Bronze ___

SPECIAL REQUESTS:_______________________________________________________________________________

PLEASE INDICATE IF YOU PREFER PHOTOS MAILED

OR E-MAILED:____________________________________

YOUR EMAIL ADDRESS FOR DIGITAL PHOTOS:

________________________@________________________

Credit Card Type: MasterCard ____ Visa ____

Expiration Date:______________________________________

Credit Card Number:__________________________________

Three-Digit Security # (on back of card):__________________

PLEASE COMPLETE AND MAIL WITH YOUR PAYMENT TO:

Always Remember Mastercard/VISA Customers:

20147 Myron Please supply your credit

(248) 477-4974