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Metro Detroit Share Keepsake Box/EPL Bag Order
Order From for Keepsake Box/Early Loss Bags
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FACILITY NAME
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Facility Address
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Facility City/State/Zip
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Contact Name
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Contact Phone #
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Contact Email
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How many keepsake boxes (designed for 20 wk +) do you need?
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How many Early Pregnancy Loss Bags do you need (designed for <20 wk gestation) losses?
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Can you pick up April 22, 2023 around 1 PM or do you need delivered?
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Any Special Instructions/Details
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