<Portrait Urn Order Form>

Please note that we do not take payments online. We will contact you to confirm the details of your order, at which time we will email an agreement. Payment will be accepted by check or credit card with 50% payment in advance and 50% upon approval of the portrait. For Inlaid Wood Silhouette Portrait Urns 100% is paid in advance.

All fields in the form with a white star are required.

*Your name:

*Your email:

Your phone number:

- -	If you prefer to conduct all correspondence via e-mail, please leave this blank.

International phone
number:

If you are outside of the USA, please enter your international phone number here.

Hours to call:

Please enter the best times to call you.

*Street Address:

*City:

*State or Province:

*Country:

*Zip Code:

*Portrait style:

Images of the portrait styles and estimated delivery times can be seen at the bottom of this page.

*Portrait Urn finish:

*Portrait Urn to hold:


	Photo Upload and Inscription Text for Individual Portrait Urns (Optional)

Name of Portrait
Subject:

Inscription, if any:

(chars left: 250)

If you would like to have an inscription engraved on the wood frame below the portrait, please type the inscription as you would like it to appear. The price for an inscription on an Individual Portrait Urn is $120.

Font to be used with
the inscription:

Available fonts can be seen on the Inscription page in the Urn Options section.

If you prefer, the photo to be used can be mailed to Portrait Urn, 612 S. 2nd St., Maquoketa, IA 52060; otherwise, you can upload a photo here:

Select a photo for
us to use for the
portrait:


	Photo Upload and Inscription Text for Companion Portrait Urns (Optional)

Name of first
portrait subject:

Please enter the name of the person whose portrait will appear on the left side of the Companion Portrait Urn.

Inscription for
first subject, if
any:

(chars left: 250)

If you would like to have an inscription engraved on the wood frame below the portrait on the left side of the Companion Portrait Urn, please type the inscription as you would like it to appear. The price for including inscriptions on a Companion Portrait Urn is $145.

If you prefer, the photos to be used can be mailed to Portrait Urn, 612 S. 2nd St., Maquoketa, IA 52060; otherwise, you can upload photos here:

Select a photo of
the first subject:

Please select a photo for us to use in the creation of the portrait of the first subject.

Name of second
portrait subject:

Please enter the name of the person whose portrait will appear on the right side of the Companion Portrait Urn.

Inscription for
second subject, if
any:

(chars left: 250)

If you would like to have an inscription engraved on the wood frame below the portrait on the right side of the Companion Portrait Urn, please type the inscription as you would like it to appear.

Font to be used with
the inscriptions:

Available fonts can be seen on the Inscription page in the Urn Options section.

Select a photo of
the second subject:

Please select a photo for us to use in the creation of the portrait of the second subject.

To order additional Portrait Urns for other family members, please enter the number of additional urns next to one or more of the Portrait Styles. Each additional urn can be created in any Portrait Style.

Inlaid Wood
Silhouette
Individual Urns:

Number of additional Inlaid Wood Silhouette Individual Urns, $795 each

Inlaid Wood
Silhouette Companion
Urns:

Number of additional Inlaid Wood Silhouette Companion Urns, $1495 each

Walnut Ink Drawing
Individual Urns:

Number of additional Walnut Ink Drawing Individual Urns, $1195 each

Walnut Ink Drawing
Companion Urns:

Number of additional Walnut Ink Drawing Companion Urns, $2195 each

Sepia Tone
Individual Urns:

Number of additional Sepia Tone Oil Portrait Individual Urns, $1495 each

Sepia Tone Companion
Urns:

Number of additional Sepia Tone Oil Portrait Companion Urns, $2795 each

Alla Prima
Individual Urns:

Number of additional Alla Prima Oil Portrait Individual Urns, $1695 each

Alla Prima Companion
Urns:

Number of additional Alla Prima Oil Portrait Companion Urns, $3195 each

Contemporary Realism
Individual Urns:

Number of additional Contemporary Realism Oil Portrait Individual Urns, $2295 each

Contemporary Realism
Companion Urns:

Number of additional Contemporary Realism Oil Portrait Companion Urns, $4395 each

Northern Renaissance
Individual Urns:

Number of additional Northern Renaissance Oil Portrait Individual Urns, $2995 each

Northern Renaissance
Companion Urns:

Number of additional Northern Renaissance Oil Portrait Companion Urns, $5795 each

Iconic Egg Tempera
Individual Urns:

Number of additional Iconic Egg Tempera Portrait Individual Urns, $2995 each

Iconic Egg Tempera
Companion Urns:

Number of additional Iconic Egg Tempera Portrait Companion Urns, $5795 each

Bronze Relief
Sculpture Individual
Urns:

Number of additional Bronze Relief Sculpture Portrait Individual Urns, $8495 each

Bronze Relief
Sculpture Companion
Urns:

Number of additional Bronze Relief Sculpture Portrait Companion Urns, $16,695 each

Archival Prints on Canvas of a Painted or Sculpted Portrait can be created so multiple family members
can share in the commemoration of a loved one.

Additional
Individual Urns with
Archival Print of
the Portrait:

Number of Individual Urns with an Archival Print of a Painted or Sculpted Portrait, $795 each

Additional Companion
Urns with Archival
Prints of the
Portraits:

Number of Companion Urns with Archival Prints of Painted or Sculpted Portraits, $1495 each

Half-size Archival Prints on Canvas of a Painted or Sculpted Portrait can also be created to be housed
in half-size Portrait Urns (minimum 2).

Additional Half-size
Individual Urns with
Print of the
Portrait:

Number of Half-size Individual Urns with an Archival Print of a Painted or Sculpted Portrait, $895 for two, each additional: $445

Additional Half-size
Companion Urns with
Prints of the
Portraits:

Number of Half-size Companion Urns with Archival Prints of Painted or Sculpted Portraits, $1595 for two, each additional: $795

Questions, comments,
or specific requests
for the portrait(s):

(chars left: 1000)

Representative ID
Number:

If you were provided with an ID number by a representative of Portrait Urn, please enter the number.

*Image Verification:

Enter the code above.

Please enter the numbers you see in the image. (This helps to prevent spam.)

Click on the Submit button below to place your order. Please note that we do not take payments online.
We will contact you to confirm the details of your order, at which time we will accept payment by check or credit card.
Thank you.

Inlaid Wood Silhouette Estimated delivery time: 2 weeks
Walnut Ink Drawing Estimated delivery time: 2 weeks per portrait
Sepia Tone Oil Portrait Estimated delivery time: 2 to 3 weeks per portrait
Alla Prima Oil Portrait Estimated delivery time: 2 to 3 weeks per portrait
Contemporary Realism Oil Portrait Estimated delivery time: 2 to 3 weeks per portrait
Northern Renaissance Oil Portrait Estimated delivery time: 4 to 5 weeks per portrait
Iconic Egg Tempera Portrait Estimated delivery time: 4 to 5 weeks per portrait
Bronze Relief Sculpture Portrait Estimated delivery time: 3 to 4 months per portrait
Archival Prints on Canvas of Painted or Sculpted Portraits Estimated delivery time: 1 additional week after portraits are completed