Memorial Order Form

Remember Me Memorial Photographs
P.O. Box 605 Elizabethton, TN. 37644
Office (423) 479-1234 Mobile (423) 291-1234 Fax (901) 471-4057
email: orders@memorialmarketing.com or remembermeorders@gmail.com
Memorial Order Form
Check one* This is:
Date*:

MonthDayYear
Date
Representative*
E-mail:
example@example.com
Name of Funeral Home/Cemetery*:
Address:
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Fun Hm /Cem Phone #:
Format: (000) 000-0000.
FH/C Fax Number:
Format: (000) 000-0000.
Name of Family Member Placing Order:
Phone*
Format: (000) 000-0000.
Memorial Selection:
Background Selection #
Text Selection #
Name of deceased:
Name as you wish it to appear on memorial (if different)
Gender: (please circle one) M F
Date of Birth:

MonthDayYear
Date
Date of Passing:

MonthDayYear
Date
Notes, Requests, Corrections: (Identify deceased if more than one person in photo / special text requests / corrections / etc)
There is a $.05 per word charge for special text not included in our selections. ($5.00 minium)
Special Background (using own bknd) Fee: $10.00 Correction Fee $7.50 each (our mistake-no charge)
Re-Orders

Tennessee Residents add 9.75% Sales Tax
Sub-Total
Sales Tax
TOTAL
CALL FOR PRICING ON LARGER PRINT SIZES AND FRAMES
(Include check, money order, or credit card info with order - make checks payable to Perspective)
Credit Card
Credit Card #
*Name on Card:
Security Code
Expiration
*Address:
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
*Phone:
Format: (000) 000-0000.
*MUST BE COMPLETED TO PROCESS ORDERS
Should be Empty:

Re-Orders