Vashon Angel Presentations Informational Questionnaire
Vashon Associates, Dept. AP, P.O. Box 345, Washington Crossing, PA 18977
http://www.angelpresentations.com	info@angelpresentations.com

Purchased by:

Name: ______________________________________________________________________________

Address: ___________________________________________________________________________

City: _________________________________________________ State: ____ Zip: ___________

Phone Number: ____-____-_____ Best time to call if more info is needed: __:___ AM PM	

Your relationship to the recipient of this gift: ___________________________________

Name of the deceased: ______________________________________________________________

Year of birth (if known): ______ Year of death: ______  Survived by: _______________

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Branch of Military Service and rank or fraternal affiliations
(Masonic, Police, Fire, etc. - if applicable): _____________________________________

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Your relationship to the deceased: _________________________________________________

Gift recipient's relationship to the deceased: _____________________________________

Gift recipient's name: _____________________________________________________________

Gift recipient's address:  _________________________________________________________

Gift recipient's city: ________________________________ State: ____ Zip: ___________

Desired signature line imprint: ____________________________________________________
(i.e., "Ellen & Robert Smith" or "Your Friends at XYZ Company", etc.) 

Please use the following space for other pertinent information. Any additional 
information you may provide will assist our artists in creating a treasured Memorial.
Of course, any and all information provided will be treated confidentially. If the 
recipient is particularly religious and/or has a favorite prayer, this information 
would also be helpful. Alternatively, we can prepare a non-religious requiem if you 
feel that would be appropriate.

Notes or Comments: _________________________________________________________________

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If more presentations are desired, please print and fill in additional order forms.
Any information that is the same as the first form, simply write "same" on those
lines.

Presentation should be sent to:   
   __Purchaser's Address   
   __Recipient's Address   
   __Other (fill in below)

Name: ______________________________________________________________________________

Address: ___________________________________________________________________________

City: _________________________________________________ State: ____ Zip: ___________

Type of Presentation ordered:
   __Two Panel Binder - $49.95 (PA residents add $3.00 sales tax)
   __Single Panel Frame - $49.95 (PA residents add $3.00 sales tax)

Payment Enclosed: $____.___
   __Money Order   
   __Company Check   
   __PayPal* (Credit Card or Funds Transfer)
   
Company Checks or Money orders should be made payable to: Vashon Associates.

*Credit Card payments may be made at PayPal.com without having to open a PayPal 
account. After you have made payment, you will receive a receipt via e-mail. 
Simply enclose a printed copy of this receipt with your order as confirmation of 
payment. 

Visit http://www.angelheartmemorials.com/pp.htm - for more information about PayPal 
payments.