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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 ($185.00 for a full silver wrap) 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.
 
Name
Phone
Email
Address
City
State
Zip Code
My preferred color mix is:
Pendant 1 (light bluish)
Pendant 2 (greenish)
Pendant 3 (dark blue/purple)
Pendant 4 (bright silver and turquoise)
Pendant 5 (black with rainbow stripes)
Pendant 6 (earthy mix)
Pendant 7 (bluish/greenish mix)
Pendant 8 (aqua/blue-green)
Pendant 9 (blue/pink/silver variegated)		 *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.
The stated price includes wrapping silver around the outside edge, leaving the pendant with a shiny black back. For $5 more, I will wrap the silver all the way around the back (for engraving purposes, for instance). Both options are equally beautiful.
Do you want the silver wrapped all the way around the back?
Yes No 		I would like the shape of my pendant to be

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 animal rescue organizations or homeless and/or abused children facilities. 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 P.O. Box 4128, Federal Way, WA 98063.)
PayPal (Payment button provided upon form submission)
Security Code: *
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