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Memorium/Recipient Donation Form

Please fill in the required information below so we may send a card or email to acknowledge your gift in the name of your recipient. Once you hit submit, you will be directed to our secure on-line donation page.

Your Name: Your Email:
Recipient's Name:    
Recipient's Address (Check this box to send a card, then enter recipients mailing address.)
Street:    
City:    
State:  
Zip:    
Country:    
Recipient's Email (Check this box to send an email, then enter recipients email address.)
Recipient's Email:     
       
 
Occassion:
(ex. Memorium, Birthday, Holiday)
   
Add a note to recipient:    
       
       
          
 
 

1-888-859-3964      •    535 W. County Road 1450 N.   •   Batesville, IN  47006

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