Selections & Order Form

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Please complete the order form. Upon completion of the worksheet and hitting the “SUBMIT” button, it will be sent to my email address, where I'll pick it up and will await arrival of your cremains and a photo, if you're sending one (it will be returned to you).

The pendants are $180.00 plus $8.95 s&h. For shipments within Washington state, add 9.5% sales tax. No tax on shipments outside Washington state. All pendants will be sent via certified mail to ensure safe delivery.

Please note that photos do not do justice to this incredibly beautiful, luminescent glass. They are provided merely to give you an idea and help you choose a color scheme.

Also, I may substitute your glass choice with a very close comparable one as there are several dichroic glass manufacturers, and their colors may be closely-matched but not identical.

Name

Phone

Address

City

State

Zip Code

My preferred color mix is:
Pendant 1 Rainbow Ripple
Pendant 2 Emerald Green Ripple
Pendant 3 Deep Blue Ripple
Pendant 4 Spring Green Ripple
Pendant 5 Deep Blue/Purple Shift Ripple
Pendant 6 Fiery Autumn Ripple
Pendant 7 Silver Cross w/ash center

*If possible, I would prefer a pendant with this/these color(s):

*I will be increasing my glass inventory based upon request and will do my best to fulfill your color wishes.

Do you want a full silver wrap or a black back?
Full wrap Black back

In what shape would you like your pendant?

Please tell me whether your cremains are human or pet (if pet, what species)

What memory stands out the most in your mind when you think of your departed one?
(This will give me a mental image to work with and could maybe include a quirky behavior, a color that you associate with him or her, or a particularly outstanding personality quality.)

I would like to have the cremains inside my pendant identified on my Certificate of Authenticity by the name:

Birth and death dates of deceased (for certificate, if desired):

Birth

Death

Brief epitaph (for certificate, if desired) :

Your questions for me, if any:

For each pendant, $5.00 will be donated to an animal-rescue organization or a homeless and/or abused children facility. Please tell me where you picked up your Katznglass brochure, or if you heard via word-of-mouth. This is important. Thank you!

Payment Method
Check (After form submission, please send your check and ash cremains to Katznglass, P.O. Box 3502, Federal Way, WA 98063.)
PayPal (Payment button provided upon form submission)

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