Lamontagne Vault Order Form
Lamontagne Vault Order Form
Phone 800-258-6566 or Fax- 508-476-3639
*
Required
Funeral Home:
*
Funeral Home Email: ***If you Do Not Receive an Email Confirmation, Please Call Us.
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Day of Service:
Day of Service:
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/
MM
/
DD
YYYY
Time of Service:
Time of Service:
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:
HH
MM
AM
PM
AM/PM
Place of Service:
Time of Cemetery Arrival:
Time of Cemetery Arrival:
*
:
HH
MM
AM
PM
AM/PM
Cemetery:
*
Cemetery City and State:
*
Cemetery Lot:
Vault Model:
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Color:
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Choice of Emblem:
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Deceased:
*
Year of Birth:
Grass & Device:
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Grass & Device:
Yes
No
Other
Other
Above Ground Seal (Wilbert Way):
Above Ground Seal (Wilbert Way):
Yes
No
Tent:
Tent:
Definite Yes
Definite No
If Stormy
Chairs:
Chairs:
Yes
No
Funeral Director:
Other Instructions: