Ashes in Glass Customer Details Form.
Please complete this form in full, sign it and post it back to us with the ashes and other
required documentation. Details below.
P. O. Box #
Product Code: e.g. N100
Price: (In US Dollars)
Invoice Number: (Prepaid Customers Only)
I hereby give Lorna Reade (Ashes in Glass) permission to encase,…………....………,
ashes into glass. I will not keep Ashes in Glass or any of their affiliates responsible for
any losses or damages.
Please post the completed form, receipt of purchase, copy of death certificate and two
teaspoons of ashes to the following address.
Lorna Reade What you need to post with this form:
Ashes in Glass
158 Durban Street * Copy of receipt. (Only for prepaid customers)
Worcester * Copy of death certificate. (Only for human ashes)
6850 * Two teaspoons of ashes sealed in plastic holder.
Western Cape * If you are going to pay via cheque, then please send it
South Africa with your ashes.
P.S. Please post these four things to us with an
Any comments: express courier service for the best response time.