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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 *

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Address *

City *

State *

Zip Code *

County

Phone *

Alt Phone

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Country *

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Deceased Person Information

First Name *

Last Name *

Height

Weight

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Order Summary

LA PIETA - Dark Walnut POPLAR - VENEER

<p>Click on the Image for a Larger Photo of the Casket!<strong>Quality made. Cal...

$1,799.99 ~~$4,999.99~~

LA PIETA - Dark Walnut POPLAR - VENEER x 1 $1,799.99

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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

LA PIETA - Dark Walnut POPLAR - VENEER

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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

LA PIETA - Dark Walnut POPLAR - VENEER