Please Fill Out This Form

Pet Bronze 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)
   


 

 

*

CONDITIONS and TERMS of PURCHASE
By submitting this order, I hereby agree that I have investigated and can verify that this 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.

 

 

 

Previous Page

To Order By Fax

 

 

 

 

Phone: 1-877-723-5677  |  Fax: 1-775-206-3313 |  Email:  sales@cemeterybroker.com

www.cemeterybroker.com