Zamówienie OnLine

With personal care and respect we maintain resting places of your loved ones in cemeteries of all denominations in entire Poland.

* obowiązkowe / required.

CUSTOMER INFORMATION

First and last name: *

Adress: *

Tel.: *

E-mail: *

DECEASED INFORMATION

First and last name: *

Date of birth:

Date of death:

Maiden name:

Relation to the Customer:

GRAVE INFORMATION

City: *

Region: *

Cementary name / street:

I don't know

Size:

single

double

tomb

i don't know

Nr of sector / avenue:

Any additional information that could be helpful :

You havecharacters left.

TYPE OF SERVICE

1. BASIC CARE (cleaning the grave and the sourroundings, two little lights)

Please allow 10 days to schedule our service. We reserve the right to refuse your request and issue full refund if we can't meet your schedule.

Date of service(s):

2. LIGHTS (Two lights are included in basic service)

Small light:

- how many lights:

- date of service(s):

Middle light:

- how many lights:

- date of service(s):

Big light:

- how many lights:

- date of service(s):

3. FLOWERS

Sort:

live

artificial

mix

Ribbon:

with dedication

Silk ribbon with dedication

Text on robbon:

With basic service:

yes

no

Date of service(s):

4. ADDITIONAL SERVICES

Following additional service are individually priced on request. We will be happy to provide personal quotation for services you select

5. OTHER REQUESTS

ADDITIONAL QUESTIONS OR COMMENTS:

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I've read and accepted the terms and conditions of services provided by EternalFlame.pl

All submitted information is correct to the best of my knowledge.

I give consent to EternalFlame.pl to use my personal information I am providing here to prepare customised offer, process the payment and perform services as requested. I understand I have the right to access all my personal information and request change and/or deletion.

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