Wood Pet Urn Order Form

Solid Wood Pet Urns (circle one)                                                       Your Pet's Weight: ________lbs.

A0-A5                           B1-B4                              T1-T2                              *X1-X2  *Only available for pets under 19lbs.
$65.00                          $65.00                             $65.00                             $65.00
*Specify your pet's weight for proper size.

Wood Finish (circle one)
Natural                      Mahogany                      Oak

Lettering Styles (circle one)
Times New Roman                          Monotype Corsiva                             Other: _____________

Optional Paw Prints (circle one)                       
Yes                No                                                      


Rough Layout (clearly print lettering & indicate desired placement)

                                                                                                                                      Letter Placement (circle one)
                                                                                                                                            Lid Top                    Side





Billing / Shipping Address

Name: ___________________________________________________

Address: _________________________________________________

City/State/Zip: _____________________________________________

Phone: ___________________________________________________

email: ____________________________________________________


CHARGES & PAYMENT METHOD (circle one)

VISA                MASTERCARD                DISCOVER                AMERICAN EXPRESS                PERSONAL CHECK


CREDIT CARD NUMBER: _________________________________  SIGNATURE CODE:_______  EXP. DATE: ______________


SIGNATURE: _______________________________________________
               (REQUIRED)

MERCHANDISE TOTAL:   $_____________

SHIPPING/HANDLING:     $_____________ (see below)

SALES TAX:                     $_____________ (Ohio only add 7.5%)

TOTAL CHARGES:            $_____________

Shipping                                                                            Make Checks Payable & Mail Order To:
Please Allow 2-3 weeks for delivery.                                   Stevenson's Everlasting Memories
Add $10.00 s/h for all Urns.                                                  1927 East Wheeling Avenue
*Model X1-X2 only available for pets under 19lbs.               Cambridge, Ohio 43725
*Specify your pet's weight for proper size.                            Tel: 1-866-584-4381  (740) 432-4599