Kahny Inc. - Memorial Card Order Form

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* = Required information.

Your Contact Information
* = Required contact information.
First Name**:
Last Name**:
Organization Name:
Address:
City:
State/Prov./Terr.:
Zip-Postal Code:
Phone**:
Ship to address:
Email*:
CC Email:	(Copy my mail to this address.)

Instructions: Enter data exactly as you would like it to appear for the card below. Click Send to enter your order.
Card Series *
Prayer Style *
Name of deceased *
Nee (Maiden Name)

Gender of Deceased	Female Male
Date of Birth (ex. May 21, 1931)
Date of Death (ex. April 1, 2003)
Date and Hour of Service
Held at
Clergy
Place of Interment

Well Fortified with the Sacraments of the Holy Church?	No Yes

Do you request Funeral Home name to be printed on card?	No Yes

Do you want to add a photo to the card?	No Yes
You have selected that you would like to add a photo to this order. Please add file of photo below...
Date Needed *
Time Needed *
Quantity *
Ship Via:
Ship To *	, ,
Notes

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