Cemetery Database Order Form

Date:

 

Name:

 

Organization:

 

Address:

 

City:

  State:   Zip Code:  

Telephone No:

 

E-Mail:

 

 

 

Price: $49.95 Indicate Payment Method Below

___ Check
___ Money Order
___ Visa
___ MasterCard
___ American Express

 Credit Card Number: ____________________________________ Expiration ________

Authorized Card Holder Signature: ___________________________________________

Date: _________________

 

 

 

Send To:    ADvantage Design Services
                  2515 Ivy Stone Trail
                  Buford, GA 30519

 

 

 

 

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