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Eternal Star
Silver Obituary - Memorial
Order Form
Website Recipient's Name:__________________________
Birthday:__________
Purchaser Name:__________________________________
Address:_________________________________________
________________________________________________
City:__________________________
State:______ Zip:__________
Telephone:_______________ Email:__________________________
Credit Card Number:__________________________
Expiration Date:__________ Security Code:______
Print this page, fill it out and send a printed copy of the obituary or memorial which has been printed in a newspaper.
A one-time fee of $50.00 will keep the obituary or memorial posted on the internet forever.
Mail to: Or FAX to (219) 769-6035 For telephone order, please call (219) 775-5752 Our email is:
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