Fuller Radiance Lamp Order Form
This form is for customers and authorized businesses to place orders for customized memorial lamps. Please ensure that you have obtained full consent from the customer before submitting.
Are you a customer or a business?
*
Please Select
Customer
Business
Back
Next
Business Order Form
By submitting this form, you confirm that the individual listed as the customer has authorized the purchase and/or customization of this product from Fuller Radiance LLC. If you are submitting this order on behalf of a customer (such as through a funeral home, florist, or gift provider), you affirm that you have obtained the customer’s full consent to share any personal information (including images, names, and delivery details) and to act as their representative in this transaction. Fuller Radiance LLC is not liable for any misrepresentation, lack of consent, or incorrect information provided by a third party on behalf of a customer. All customized products are produced based on the information submitted in this form and are considered final once production has begun. By proceeding, you agree to our Terms of Sale, Privacy Policy, and any applicable agreements between Fuller Radiance LLC and its business contracts.
Business Name
*
Contact Name
*
First Name
Last Name
Contact Email
*
example@example.com
Consent Confirmation
*
I confirm that I have obtained the customer's consent to place this order on their behalf.
Back
Next
Customer Order Form
By submitting this form, you confirm that the individual listed as the customer has authorized the purchase and/or customization of this product from Fuller Radiance LLC. If you are submitting this order on behalf of a customer (such as through a funeral home, florist, or gift provider), you affirm that you have obtained the customer’s full consent to share any personal information (including images, names, and delivery details) and to act as their representative in this transaction. Fuller Radiance LLC is not liable for any misrepresentation, lack of consent, or incorrect information provided by a third party on behalf of a customer. All customized products are produced based on the information submitted in this form and are considered final once production has begun. By proceeding, you agree to our Terms of Sale, Privacy Policy, and any applicable agreements between Fuller Radiance LLC and its business contracts.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Consent Confirmation
*
I consent to the processing of my personal information for the purpose of fulfilling this order.
Back
Next
Order Form
By submitting this form, you confirm that the individual listed as the customer has authorized the purchase and/or customization of this product from Fuller Radiance LLC. If you are submitting this order on behalf of a customer (such as through a funeral home, florist, or gift provider), you affirm that you have obtained the customer’s full consent to share any personal information (including images, names, and delivery details) and to act as their representative in this transaction. Fuller Radiance LLC is not liable for any misrepresentation, lack of consent, or incorrect information provided by a third party on behalf of a customer. All customized products are produced based on the information submitted in this form and are considered final once production has begun. By proceeding, you agree to our Terms of Sale, Privacy Policy, and any applicable agreements between Fuller Radiance LLC and its business contracts.
Shipping
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Upload photos to be used in lamp (More than 4 photos per lamp will incur additional charges)
Browse Files
Drag and drop files here
Choose a file
If you are providing photos over email, text message, or a physical copy, leave this section blank.
Cancel
of
My Products
*
prev
next
( X )
Cordless Lamp
4 photos default per lamp
$
200.00
Quantity
1
2
3
4
5
6
7
8
9
10
Corded Lamp
4 photos default per lamp
$
165.00
Quantity
1
2
3
4
5
6
7
8
9
10
Small Corded Lamp
4 photos default per lamp
$
145.00
Quantity
1
2
3
4
5
6
7
8
9
10
Additional Photos
If you are ordering more than 4 photos for a lamp
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Photo Count
Back
Next
Please verify that you are human
*
Back
Next
Signature
Should be Empty: