Order Form Cremation Urns


 
 
Use this form to order.
Fill in as much information as possible before you click 'SEND'.
 * - Indicates items NECESSARY to process your request

PHONE
1.877.723.5677 toll free
310.316.1373 local
775.599.8591 fax

  

MAIL
John M Harris Co.
Cemetery & Funeral Consultants
226 S Lucia Ave Suite #1
Redondo Beach CA 90277
 
Mr/Mrs/Dr
 First Name*
 Last Name*
 Job Title
Mailing Address*
 Extended Mailing Address
City*
 State*
 		Zip*
Phone Number*
 Fax Number
 Country
Email Address*
 How did you find us?
Referral ID* N/A if no contact
  



  Which urn item/s are you requesting:

We will call you to collect your credit card information.
How would you like us to contact you?     Home Cell  
Office E-mail
When is the best time to contact you?     Daytime
 Weekend  
Evening Anytime


CONDITIONS and TERMS of PURCHASE

By submitting this order, I hereby agree that I have investigated and can validate that this cremation urn 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)

Check this box, if you wish us to call you to process your credit card information (Please click here)

 

*

 

**All supplied information**
will be held for internal use only and will not be sold or distributed to third parties

 

 

Please Fill Out Our
Cremation Urn Order Form
above and this
Billing Form
if
Mailing or Faxing Your Order 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

Signature Date



To Order By Mail or Fax

or pay with

PayPal