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Casket Order Form

Quantity *

Shipping Address

Name *

Address *

City *

State *

Zip Code *

Is this address a mortuary or funeral home?

Receiving Funeral Information (If available)

Contact Name

Phone

Fax

Desired date and time of the funeral viewing/services (Not required to order casket)

Date (DD/MM/YY)

Time

Buyer Information

Title

First Name *

Last Name *

Email *

Confirm Email *

Address *

City *

State *

Zip Code *

County

Phone *

Alt Phone

Fax

Country *

Relationship to the deceased *

Shipping Options

Please select one *

Standard Delivery

Overnight Delivery

2 Day Rush Delivery

3 Day Rush Delivery

Overnight Saturday Delivery

Deceased Person Information

First Name *

Last Name *

Height

Weight

Additional Information

Comments

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* We will contact you immediately to confirm your order and arrange payment

Order Summary

Bronze - Winchester Half Couch 32oz Sealer

<p>CALL US NOW TOLL FREE 1-800-550-7262 FOR ANSWERS TO YOUR QUESTIONS! Proudly M...

$5,999.99 ~~$15,995.99~~

Bronze - Winchester Half Couch 32oz Sealer x 1 $5,999.99

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Casket Order Form

Shipping Address

Receiving Funeral Information (If available)

Buyer Information

Shipping Options

Deceased Person Information

Additional Information

How did you hear about us?

Order Summary

Bronze - Winchester Half Couch 32oz Sealer

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Casket Order Form

Shipping Address

Receiving Funeral Information (If available)

Buyer Information

Shipping Options

Deceased Person Information

Additional Information

How did you hear about us?

Order Summary

Bronze - Winchester Half Couch 32oz Sealer