Statement Credit Promotion

Complete the form below to submit a PROMOTIONAL order for your customer to Customer Service. A confirmation of the order will be sent to the email below after it is processed.

Sales Professional Email*

A confirmation of the order will be sent to the email below after it is processed.

Bill to Account Number*

Bill-to Account Name*

Ship-to Account Number*

Enter "same" if the ship to is the same as the bill to.

Ship-to Account Name*

Enter "same" if the ship to is the same as the bill to.

Delivery*

Date Needed*

Please note: delivery fees may apply if date selected is not a normal delivery day.

Product Order

Casket PO (purchase order name or #)*

If not required, enter: n/a

Casket Item Number*

Casket Description*

Casket Quantity*

Casket for stock, at-need or not disclosed?*

Casket first viewing date:*

Casket Accessories Needed?*

Casket Quantity for Accessories*

Example: "1"

Casket Description for Accessories*

Example: "Cross"

Casket Item Number for Accessories*

Example: "243714"

Additional Notes

Please add any additional notes for the FDAC team.

Statement Credit Promo Order

Product Order

Additional Notes

Confirm and Submit Order