Order Form

- Order Form -

Thank you for ordering your truly unique and beautiful heirloom quality

Memory Mirror and/or Reliquary Chest

from

Please allow 4 - 8 weeks for delivery.

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
FAX
E-mail
URL

3 Easy Steps

Step 1	Select Style of Memory Mirror (see Mirror codes)

	Select Size of Reliquary Chest


Step 2	Select Finishing Code


Step 3	Custom Features
	I would like to personalize my choice with:


Step 4	Custom personalization items (please send your custom personalized items to Yartys.com, 1727 England Ave, Courtenay, BC, Canada, V9N 2P5)
	Personal Items have been sent
	No Personal Items are required
	Personal Items (waiting for further info)

Shipping	Your order will be safely packaged, insured and sent by the most economical means available unless otherwise instructed.

Special Instructions