ORDER FORM




Name of Deceased:

Date of Birth:
Date of Death:

(mm/dd/yyyy)

 
Family Contact:
Relationship:

Address:
Phone # :

City:
State:
Zip:
 
 

Special Requests:

Permission for the use of any copyrighted photos supplied to Loving Memories of Memphis is the responsibility of the provider.

Photos will be returned. Send only one photo no larger than 8x10. You can also e-mail us your photo as a JPG attachment.


 


***** FOR FUNERAL HOME USE ONLY *****

Name of Counselor:
Name of Funeral Home or Cemetery:

Address:
Phone # :


City:
State:
Zip:
 

This is a New Order (Please include Photo.)     This is a Reorder


PACKAGES
INCLUDES
PRICE
QUANTITY
TOTAL

Value Package A
(1) 8x10, (2) 5x7's, (4) 4x6's, (2) Bookmarks*
$50.00        X
=
Value Package B
(1) 8x10, (2) 5x7's and (4) 4x6's
$45.00        X
=
Value Package C
(1) 8x10, (2) 5x7's and (2) 4x6's
$40.00        X
=
Value Package D
(1) 8x10 and (4) 4x6's
$35.00        X
=
Value Package E
(1) 8x10 and (2) 5x7's
$30.00        X
=
Value Package F
8 x 10's (each)
$15.00        X
=
Value Package G
5 x 7's (each)
$7.50          X
=
Value Package H
4 x 6's (each)
$5.00          X
=
Bookmarks
Bookmarks* (each)
$5.00          X
=
*Copy of obituary needed!
Sub Total
Sales Tax
9.25%
Shipping and Handling
Total Due


Loving Memories of Memphis
Duane and Beverly Hilton
4450 Guinevere Lane
Bartlett, TN 38135
(901) 388-0152