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
Date
to Memorialize
Name
Pet
Type
Flower
Color
Notes,
comments and/or questions
We
now accept
PICK-UP SERVICE AVAILABLE $25.00 FEE PLUS
$1.00/MILE
