Manufacturers of
Concrete Burial Vaults • Double Depth Lawn Crypts • Cremation Urns
Vault Order Form
From: __________________________________
__________________________________
__________________________________
Phone: ____________________________ Fax: _________________________
Ordered By:
____________________________ Date: ________________________
Type of Vault/Description: _________________________________________________
______________________________________________________________________
Name of Cemetery/Location: _______________________________________________
______________________________________________________________________
Name of Deceased: ______________________________________________________
Contract #: ______________________________
Type of Service:
FH Chapel ( )
Church ( )
Graveside ( )
Time of Service: __________________________
Date of Service: __________________________
Special Instructions:
Open & Close w/Set-Up ( )
Open & Close w/No Set-Up ( )
Set & Seal ( )
Extra Tent ( )
Set-Up Only ( )
Extra Chairs ( )
______________________________________________________________________
______________________________________________________________________
Bill to: Cemetery: ________________________________________________________
Funeral Home: ____________________________________________________
Phone: (352) 567-2138 • Fax: (352) 567-0406 • 14621 Roberts Barn Rd • Dade City, FL 33523