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Casket Order Form

Quantity *

Shipping Address

Name *

Address *

City *

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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)

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Buyer Information

Title

First Name *

Last Name *

Email *

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Address *

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State *

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Deceased Person Information

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Last Name *

Height

Weight

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Order Summary

Regal Wineberry Full Couch Casket with Gasket/Lock

<p><strong>Click on the Image for a larger Photo!</strong>CALL US NOW FOR ANSWER...

$1,399.99 ~~$3,999.99~~

Regal Wineberry Full Couch Casket with Gasket/Lock x 1 $1,399.99

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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

Regal Wineberry Full Couch Casket with Gasket/Lock

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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

Regal Wineberry Full Couch Casket with Gasket/Lock