Print This Page           Please print, fill out & mail along with your check or money order to:
                                                                L. Huffman Studios
                                                               5014 S. 3rd Avenue
                                                           Everett, WA 98203-4133
                                                             Phone: 425-252-2742

When your order is processed, you will be sent a pre-stamped kit containing a vial and/or a hair sample card,
a complete set of instructions and a selection form. Upon receipt of the kit please place a small amount of
crematory ash (approx. 1/4 teaspoon) in the vial, fill out the selection form and return the kit to us so that
Linda can custom make your Memory Pendant to your specifications.

SHIPPING ADDRESS FOR KIT

NAME ___________________________________________________________________________________

ADDRESS_______________________________________________________________________________________________

CITY________________________________  STATE & ZIP CODE___________________________________

PHONE______________________________ E-MAIL _____________________________________________

Number of original pendants ordered ______ at $70.00each                                                                    __________

Number of oval hanging memorials ordered ______ at $85.00 each                                                       __________

Number of worry stones ordered_______ at $80.00 each                                                                         __________

Number of spiral stands ordered ______ at $15.00 each                                                                           __________

Number of gothic stands ordered ______ at $18.00 each                                                                         __________

Number of small silver pendants ordered ______ at $135.00 each                                                          __________

Number of large silver pendants ordered ______ at $165.00 each                                                          __________

Number of small opal style keepsake pendants ordered ______ at $135.00 each                                __________

Number of small original style keepsake pendants ordered ______ at $135.00 each                          __________

Number of large opal style keepsake pendants ordered ______ at $165.00 each                                __________

Number of large original style keepsake pendants ordered ______ at $165.00 each                          __________

Number of small combination keepsake/cremains pendants ordered ______ at $155.00 each          __________

Number of large combination keepsake/cremains pendants ordered ______ at $185.00 each          __________

Less discount if applicable (authorization # __________) (Please contact us first)                          __________

                                                                                                                    Sub-total                                       __________

                                                                                   8.6% tax if in Washington State                                __________

                                                                                                                          Total                                       __________