Order form

I would like to order a Portrait Urn Basic

Format*

3 in high (7.5 cm)7 in high (17.5 cm)11 in high (27.5 cm)

Color*

Dark BronzeBronze ClassicOcre SandLagune BlueLagune Green

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You can also submit photos via WeTransfer (maximum of 1 GB in total, free to use)
or via a similar service to info@portreturn.nl.

Comments and/or special requests:

Your details

Family or organization*

Contact person*

Address*

Zip code*

Place name*

State*

Country*

Phone number*

Email*

Details of the deceased
Important when a significant date is approaching.

Name:

Date of birth:

Date of death:

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