Chance Designz Memorial Merch Order Request

Chance Designz Memorial Merch Order Request

Please complete the form below with as much detail as possible to help us create respectful and personalized memorial items.
Contact Information
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Contact Method

CallTextEmail
City and State
Loved One’s Information
Loved One’s Full Name*

First NameLast Name
Sunrise Date

MonthDayYear
Date
Sunset Date

MonthDayYear
Date
Theme or Style Requested
Favorite Colors
Special Quote, Scripture, or Wording to Include
Upload Photos of Loved One

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Memorial Item Selection
Please select all memorial items you wish to order*

Memorial T-ShirtsHoodiesSweatshirtsLong Sleeve ShirtsMemorial ButtonsDog TagsMemorial BraceletsMemorial NecklacesFoam Board PosterMemorial PosterMemorial FansCasket Panel DesignGrave Blanket DesignMemorial Garden FlagMemorial VideoDigital Memorial FlyerSocial Media Tribute DesignOther
Please describe any additional memorial item needed
Apparel Order Details
Apparel Type Needed
Shirt Color
Print Color Preference
Quantity Needed
Sizes Needed (Please list quantity per size for Youth and Adult)
Design Placement

Front Only DesignFront and Back Design
Need individual names on shirts?

YesNo
Need a family name or group name on design?

YesNo
Date items are needed by*

MonthDayYear
Date
Keepsake and Display Item Details
Which keepsake or display items are you ordering?
Quantity needed for each selected item
Size needed for posters, boards, or panels
Specific wording to place on each item
Upload additional photos if needed

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Memorial Video / Digital Design Details
Are you requesting a memorial video?

YesNo
Preferred video length
Song request or music style
Social media tribute design needed?

YesNo
Date digital items are needed by

MonthDayYear
Date
Design Instructions
Please describe your vision for the design
Preferred design style
Any examples or inspiration to match?
Upload inspiration images

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Pickup / Delivery
Order Type

PickupLocal DeliveryShipping
Shipping Address (if applicable)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Event or Service Date

MonthDayYear
Date
Rush Order Needed?

YesNo
Payment and Approval
A design mockup will be created after all details are received. Production will begin once the design is approved and payment terms are confirmed.
I understand that all custom memorial items require approval before final production.*

I acknowledge
I confirm that all names, dates, and uploaded photos are correct to the best of my knowledge.*

I confirm
Final Notes
Additional Notes or Requests
We appreciate the opportunity to help you honor your loved one. Once your form is submitted, Chance Designz will review your details and follow up to confirm the next steps.
Should be Empty:

Chance Designz Memorial Merch Order Request

Contact Information

Loved One’s Information

Memorial Item Selection

Apparel Order Details

Keepsake and Display Item Details

Memorial Video / Digital Design Details

Design Instructions

Pickup / Delivery

Payment and Approval

Final Notes