(The following information is required)
Sent From:___________________________________________
Name:_______________________________________________
Address:_____________________________________________
City, State, ZIP:________________________________________
Phone:______________________________________________
Email:______________________________________________
Relationship to Deceased:______________________________

Ship to:
Pacific Memorial
Box 1477
Crescent City, CA 95531
541 251 4562

US Postal Service - Please request "registered mail" and "return receipt" when shipping.

DATE SHIPPED:____________________________________

SHIPPED VIA:______________________________________

Send Additional Memorial Certificates to:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

• Put the container in a padded shipping box - your mortuary or funeral home can provide you with one.
• Unless paying by credit card, enclose your check or money order payable to: Pacific Memorial.
• Include any original disposition papers (burial papers) you received from the mortuary or crematory (make copies of these for your records if you wish).
• Include a signed copy of the authorization for scattering of ashes.
• Please enclose a copy of the death certificate, unless this was faxed to us previously.
• Include this order form (make a copy for your records).
• Ship to above address - U.S. Postal Service accepts cremated remains for transport (request registered mail and return receipt when shipping).
• Mark the outside of the package on the address side "Cremated Human Remains".