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FAX
Fill in form below and print using browser or print blank form and fill in by hand if desired. Include credit card information and fax to Distinctive-Urns, Fax# 1-614-890-2212

MAIL
Same as above. If you prefer, enclose a check and mail form to Distinctive / Discount Urns
220 South State Street Westerville, OH 43081

PHONE
Print order using browser and then call Distinctive Urns at (614) 882-2121 and place your entire order by phone.

Purchase Order

 

Order Form:

Ordering Information:
Mail it to:
Distinctive Urns
Mr. Frank E. Hill Jr.
220 South State Street
Westerville, OH 43081

Shipping Information

 

Name: __________________________________

Address: _______________________________

City: __________________________________

State/Province: ________________________

Postal/Zip Code:________________________

Phone: _________________________________

Country: _______________________________

Billing Information

Credit Card:   VI   MC   

Number: ________________________________

Exp. Date: _____________________________

Name: __________________________________

Address: _______________________________

City: __________________________________

State/Province: ________________________

Postal/Zip Code:________________________


Quantity Model # Description Subtotal
(in US dollars)
    Sub-Total $0
*Sales tax will be applied to all orders by Ohio residents.

Special Instructions: