MEMORIAL CANDLE : ORDER FORM


E-mail Address

Date Required

(dd/mm/yyyy)Quantity

Customer Name

Contact Telephone

(preferably mobile)

Shipping Address

(street)

(suburb)

(state)  (postcode)

Payment Method

Name of the Deceased

M F

Date of Birth

(dd/mm/yyyy)

Date of Death

(dd/mm/yyyy)

Ribbon Colour

 

Layout

Please select the options you wish to include on this page.

Title Line:

Name of the Deceased

Photo or Picture (upload below)

Date of Birth

Date of Death

Photo or Picture

You may upload a photo or picture here,

or select one of our stock pictures below:

Religious images
Contemporary images

Additional Instructions

Pricing (AU$)

 

Price per Unit

Shipping

Total

 

I have read and accept the Terms and Conditions