Ted Dickey Order Form
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Email address
*
Your email
Delivery Location
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Choose
Ted Dickey Funeral Home - 309728
Ted Dickey West Funeral Home - 309696
Funeral Director
*
Your answer
Funeral Director Email Address
*
Your answer
Name of Deceased
*
Your answer
Case #
Your answer
Delivery Information
Flowers will be delivered 2 hours prior to viewing, visitation or service.
Will there be a private viewing?
*
Yes
No
Private Viewing Date
MM
/
DD
/
YYYY
Private Viewing Time
Time
:
AM
PM
Will there be a visitation?
*
Yes
No
Visitation Date
MM
/
DD
/
YYYY
Visitation Time
Time
:
AM
PM
Service Date
*
MM
/
DD
/
YYYY
Service Time
*
Time
:
AM
PM
Include Bud Vase?
*
Yes
No
# Boutonnieres at no charge (up to 8)
*
Choose
0
1
2
3
4
5
6
7
8
# Additional Boutonnieres @ $12.95 each
*
Your answer
Family Piece #1 - Enter Quantity, Description & Price
*
Your answer
Family Piece #2 - Enter Quantity, Description & Price
Your answer
Family Piece #3 - Enter Quantity, Description & Price
Your answer
Family Piece #4 - Enter Quantity, Description & Price
Your answer
Order Total $
*
Enter Order Total (Total amount for family pieces & additional boutonnieres)
Your answer
Additional Information
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A copy of your responses will be emailed to the address you provided.
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