Prepay Order Form
Fields marked with an asterisk are required.
Please check if you are:
*
An Alumnus/Alumna of Saint Meinrad
A Deacon or Deacon's Spouse
An Oblate of Saint Meinrad
Not affiliated but would like information
Name of casket beneficiary, intended user (first, middle initial, last):
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Current Age:
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Date of Birth:
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First Name of Policy Holder:
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Last Name of Policy Holder
*
Relationship to insured (if different than casket beneficiary):
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Address:
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City:
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State:
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Select
AK
AL
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code:
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Phone:
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Email:
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Form of Payment
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Credit Card (Visa, Mastercard, Discover, American Express)
Electronic Funds Transfer (EFT)
Check
Choose from the casket selections below:
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Traditional Cherry Abbey Casket, Cherry Finish
Traditional Cherry Abbey Casket, Natural Finish
Traditional Oak Abbey Casket, Medium Brown Finish
Traditional Poplar Abbey Casket, Cherry Finish
Traditional Poplar Abbey Casket, Natural Finish
Traditional Large Poplar Abbey Casket, Cherry Finish
Monastic Poplar Abbey Casket, Cherry Finish
Monastic Poplar Abbey Casket, Naturaly Finish
Additional Full Body View Option for Traditional Caskets:
Yes
No
Additional Keepsake Crosses:
Gold Corpus
Silver Corpus
Deacon Sash
Deacon Wife Sash
Engraving
No additional crosses
How many additional crosses would you like?
Additional Comments or Questions:
Click to Submit