To
order your Keepsake by Lauri please fill in the
following information and hit the submit
button. If you have any questions or
problems about this form or you would
rather order over the phone then please call Lauri
at 603-882-6977
Your E-mail:
Customer Information
Full Name
Home Phone No.
Work Phone No.
Cell Phone Number
Fax Phone Number
Street Address
City
State
Zip
Keepsake
Information
Item
type
Frame
Size
Supplier
Style#
Color
(If Applicable)
Background
Choice
Weddings
Fill in this section for wedding bouquets
Wedding
Date
Name
of
bride:
Name
of Groom
Memorials:
Fill in this section for memorials
Date
to Memorialize
Name
Relationship/Title
If
not sending flowers please select color:
Flower
Color
Pet
Memorials:
Fill in this section for pet memorials
