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Spirit Weight - ORDER FORM

One teaspoon of Ashes is needed for each Spirit Weight. Place Ashes into a plastic zip-lock bag: remove air and seal the bag. Send the Ashes, order form, and check or money order to:

Marc Boutte Glass
375 Latham Way
Camano Island, WA 98282 Complete the following form and then print it out to send to Marc.

Your Name:

Street

City, State, Zip

Phone:

Please Note: Spirit Weights will be shipped to the above address unless otherwise specified.

Price per Spirit Weight = $95
Color Choices: Clear or Cobalt Blue centers

Number of Clear Centered Weights
Number of Cobalt Blue Centered Weights
Total number of Spirit Weights (x$95)
Washington State residents add 8.4% sales tax
Sub Total
Add Shipping and Handling ($8) add $5 per additional weight
Grand Total Enclosed

Engraving Information

Engraved Name:

Engraved Date(s):

Please make checks payable to Marc Boutte Glass


Copyright 2006, Marc S. Boutte
375 Latham Way, Camano Island, WA 98282
360-387-2162 Email: msboutte@marcboutteglass.com

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