Pulliam Funeral Home
Oblong, Illinois

PLEASE PRINT

Please make an ornament inscribed with the name of :____________________________

who passed away on ________________________________ (date)

There will be ________ members of our family or friends attending the Service.

Send request to:
Pulliam Funeral Home
P.O. Box 121
Oblong, IL 62449

Please return form NO LATER THAN December 2, 2005

**Extra Ornaments are available for $5.00 a piece if picked up at the funeral home;
Shipping & Handling to one address 1-6 Ornaments $5.00; 7-12 Ornaments $10.00;
Separate Mailing Locations: $5.00 per Ornament.
**Extra Ornaments that are ordered may be picked up or sent out after the Remembrance Service**

Name _____________________________________Phone Number _______________________