Casket Order Form

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Web www.sadloss.com

To Order

Fill out Our
Casket Order Request Form

The prices quoted excludes applicable sales tax, & shipping charges.

Please Specify:

Item Type
Product Name
Item Price
Quantity Desired
Select One?

Shipping Address:
Name
Address
City
State	Zip Code
Is this address a residence, funeral home/mortuary or cemetery?
Receiving Funeral Information: (If available)
Contact Name
Phone
Fax
Desired date and time of the funeral viewing/services:
(It is not required to order the casket)
Date	(DD/MM/YY)
Time
(Casket must arrive minimum of 24 hours prior)

Buyer Information: Fill out All Sections to Submit

Title
First Name
Last Name
Email
Street Address
City
State		Zip Code
Country
Area Code	Tel.1
Area Code	Tel.2
Area Code	Fax-line
County
Relationship to the deceased
Shipping Options

Deceased Person Information:
First Name
Middle Name
Last Name
Height
Weight
Date of Birth		(DD/MM/YY)
Date of Death		(DD/MM/YY)

I have read and I agree to the Terms and Conditions of Sale (Please click here)

We gladly accept

We accept credit cards and eChecks through
PayPal payment services.
Paper checks and Money Orders by mail.
I prefer PayPal, the #1 payment service in online auctions!

I prefer PayPal, the #1 payment service in online auctions!

What is PayPal and how to use it.

**To Order By Fax or By Mail**

Please Fill Out Our
Casket Order Request Form
above and this
Billing Form
and
Fax It to Us

Bill this order to:

Name as it appears on the card:
Billing Address
Address line 2
City
State/Province
Zip Code
Card Number
Card Type	Please select one: Visa Master Card
Expiration Date	Day Month Year
CVV2	What is CVV2?(Click Here)
Select:	Please select one: I have entered my CVV2 above My card has no CVV2 imprint My cards' CVV2 is illegible

To Order By Fax