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PLEASE PROVIDE SENDER INFORMATION: |
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First Name:
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Last Name: |
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Address: |
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Zip Code:
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City: |
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State: |
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Other
Country: |
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Home phone:
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Work phone:
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Cellular: |
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Email: |
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PLEASE PROVIDE INFORMATION ABOUT WHO PASS AWAY: |
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First Name:
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Last Name: |
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Home: |
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Funeral
home:
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Funeral
Home name: |
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Ceremony
time
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Address: |
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Zip Code:
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City: |
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State: |
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Other
Country: |
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Home phone:
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Funeral home phone:
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ORDER OUR FUNERAL AND SIMPATHY ARRANGEMENTS: |
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COLOR
FULL ST. SPRAY |
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RED
HEART STAND. SPRAY |
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PATRIOTIC
STAND. SPRAY |
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ANGEL CROSS |
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CROSS ARRANGEMENT |
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WHITE RED CROSS |
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HOPE
AND HONOR WREATH |
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LOVING STANDING
HEART
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SWEET STANDING
SPRAY
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STANDING WREATH
YELLOW
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STANDING WREATH
WHITE
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STANDING WREATH
PINK
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SPRING STANDING SPRAY |
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ETERNAL REST HEART |
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STANDING SPRAY |
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PEACE OF LILY |
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PEACEFUL
MEMORIES |
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TREASURED MEMORIES |
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SPRING
REMEMBRANCE |
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BASKET OF FAITH |
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GENTLE COMFORT
BASKET
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HOPEFUL PINK
BASKET
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COLOR FULL BASKET |
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GLORY AND GRACE
BASKET |
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VIVID
SENTIMENTS |
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LAVENDER
REMI. BASKET |
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PINK EXPRESSION
BASKET |
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WHITE
EXPRESSION
BASKET |
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YELLOW
EXPRESSION
BASKET |
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FRIENDSHIP BASKET |
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EVERLASTING
LOVE BASKET |
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GRAND SENTIMENTS
BASKET |
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ETERNAL HOPE
BASKET |
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SPATHIPHYLLUM
PLANT |
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SPATHIPHYLLUM
PLANT |
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FAITHFUL FERM |
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GRACEFUL
TRIBUTE BASKET
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BLOOMING ROSES
BASKET
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HEAVENLY WHITE RED
BASKET |
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HEAVENLY
PINK BASKET |
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CONDOLENCES ROSE
VASE |
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SYMPATHY
BASKET
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ENTER YOUR CARD MESSAGGE |
ENTER YOUR BANNER MESSAGGE |
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DATE
OF DELIVERY |
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COMMENTS OR SPECIAL INSTRUCTIONS |
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PAYMENT INFORMATION |
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PLACE YOUR
ORDER - WE WILL
CONTACT YOU BY PHONE TO COLLECT YOUR PAYMENT INFO |
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PONGA SU ORDEN
- LO LLAMAREMOS PARA PEDIR LOS DATOS DE SU TARJETA |
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Other Method |
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Credit Card |
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Card
Number |
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Credit card
Secure Code |
(3 Numbers - see back of your Card) |
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Cardholder Name |
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Cardholder
Billing address |
Complete of Zip code |
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Expiration Date |
(Format MM/YY) |
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We will contact you via
e-mail or phone shortly with your order confirmation. |
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Please verify your
information carefully before submitting for ordering. |
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