Cremulet Order Form

Please Print and mail with cremains

(Click here for instructions on how to pack and mail cremains.)

 

Basic Design Options  

STYLE (heart? oval? dogbone? etc.) COLOR SIZE To Be Worn As A Pendant? SIMILAR TO SAMPLE # QUANTITY PRICE

 

 

            

 

 

            

 

 

            

 

 

            


SHIPPING IS FREE

TOTAL PRICE:

 

Additional Information (Custom):

Please give me all the information you can about what you are looking for in a cremulet. 
If you like the mardi gras glass, please let me know!  I can have just a few black dots, a lot of dots, lines, or no lines.
 I can use the dots and lines to partially or completely conceal the ashes, if that’s what you want.
Every cremulet is made individually so I can really fine tune what your cremulet will look like.


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NAME:__________________________________________________________________________

ADDRESS:_______________________________________________________________________

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Telephone No. & Email: ____________________________________________________________

 

Payment Options:                           U.S. $ CHECKS or PAYPAL BELOW

Varieties

Otherwise please supply your Credit Card Information Below or enclose a check or Money Order when you mail cremains with this order form.

 

Credit Card Number:_____________________________________________________

Expiration Date:_________________________________________________________

Credit Card ID Number:___________________________________________________

Name and Address of Cardholder
if different from shipping address___________________________________________

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Mail With CremainsTo: Lewis Creek Glassworks, PO Box 1007, Neskowin, OR. 97149

 

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