Application Form for Heavens Link Memorial

Billing Name
Billing Address
City, State, Zip
Phone # Day
E-Mail
Info on deceased person:	Proper name in full
Name
Born
Buried
Date

In order to add links and customize memorial page please list deceased
persons favorite things, colors, music, art, heroes, hobbies and interests.

Please select a theme (index) for your memorial page

There is a one time fee to build your memorial website. $125.00.
Then there is a hosting fee to keep your memorial site up on the net.
$35.00 annual fee $150.00 Five year fee
Your memorial site includes 2 pages any additional pages will cost $45.00 per page.

Please select the type of memorial pages you would like to create.

Ist page (home)	Included
2nd page	Included
I would like an additional page.
Additional pages cost $45 each and can be added on at any time.

I have decided to have a reflections page. As long as the person
sending the reflection is on the pre-approved list their message will be
posted within 24 hours. Otherwise their message will be
forwarded to you for approval before posting.

Please list names of (family/friends) who can post reflections.

All family e-mails will be forwarded to you.
Example; a friend can e-mail condolences to:
TheEllsonFamily@HeavensLink.com
Please enter forwarding address.

Please we don't want an e-mail forward on any of our pages.
____________________________________________________________________

(Please choose one) Yes - I want a public listing with a link to my memorial site
NO - I don't want a public listing with a link. I want a private web address for my memorial site.

Heavens Link Memorial Site Agreement

The purchase of a HLM Memorial Site includes your choice of 2 pages. Up to 1000 words of text, 6 photos, plus 10 links to outside information. You will need to submit information, text, photos on disc or e-mail to HLM along with full payment before any work will begin. All memorial pages will be completed within 2 weeks after receiving information and payment.

HLM will send you a private address where you can preview the finished Memorial pages to print and edit. This address will not be linked for public viewing until we get your final approval.

YOU MUST RETURN (FAX or US MAIL) THE PROOF COPY WITH LEGIBLE CORRECTIONS NOTED THEREON WITHIN SEVEN DAYS AFTER THE DATE SENT OR HLM WILL NOT BE HELD RESPONSIBLE FOR ANY PROOF OF CONTENT.

HLM is not responsible for printer/typo errors and holds the right to cancel any publication of a Memorial page and refund payment received.

To finalize this transaction please fill out the portion below:

Print 2 times
Keep one copy for your records
SIGN and mail the second copy with your pictures, information and payment to:

Heavens Link Memorial
PO Box 4987, Kaneohe, Hawaii 96744

Form of Payment:

	I am mailing a check / money order
	I am mailing the total amount of:
	I am going to use PayPal. PayPal is the secured authorized payment processor for Wallstreet Webmasters. DBA: HeavensLink.com
Date Accepted and Agreed To:
Signature:_____________________________	Please use Initials

YOU, the buyer, may cancel this transaction at any time prior to midnight
of the third business day after the date of this transaction.

Thank You!