Granite Order Form

To Order

Fill out Our
Granite Order Request Form

      * required entries

Full Name: *(Required)

E-mail Address: *(Required)

Street Address: *(Required)

City: *(Required)

State/Prov:

Postal Code: *(Required)

Country:

Daytime Phone Number: *(Required)

Any Special Instructions On Contacting You:

Design: *(Required)

Marker Size: *(Required)

Bronze Style: *(Required)

Enter Inscription Needed: *(Required)

Name of Cemetery to Placed in*(Required)

Address of Cemetery: *(Required)

Telephone Number of Cemetery: *(Required)

Burial Location of Deceased within Cemetery: *(Required)

CONDITIONS and TERMS of PURCHASE
By submitting this order, I hereby agree that I have investigated and can validate
that thisgranite grave marker that I am ordering, conforms to all cemetery rules
and regulations or specifications held by the cemetery where it would be used. I
further agree to not hold Cemetery Broker responsible for any rejection of the
product I am ordering.

NOTICE: BY COMPLETING THIS ORDER FORM, PURCHASER HAS READ ALL
TERMS AND IS AGREEING ANY CLAIM PURCHASER MAY HAVE AGAINST
SELLER SHALL BE RESOLVED BY ARBITRATION AND PURCHASER IS
GIVING UP HIS/HER/THEIR RIGHT TO A COURT OR JURY TRIAL AS WELL
AS HIS/HER/THEIR RIGHT OF APPEAL.

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
Granite Order Request Form
above and this
Billing Form
and either
Mail or 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

Mailing Address:
	John M. Harris Co. Cemetery & Funeral Consultants P.O. Box 2191 Hawthorne, CA 90251

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To Order

Fill out Our Granite Order Request Form

Fill out Our
Granite Order Request Form