Memory Pillows Order Form

Please read the Terms and Conditions located here before placing an order.

Name *

Email address *

Pillow Size *

Small 14" Pillow - $25 each
Medium 16" Pillow - $30 each
Large 18" Pillow - $35 each

How many of each size: *

When Do You Need Them Completed By?

Personalization Options

Any Text - Dates on feet, name, etc ($5 each)
Signature Replication ($5 each)
Picture ($5 each)

Personalization Details:

Upload Picture or signature (If applicable)

Any Additional Information

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I have read the Terms & Conditions on the 411 On Ordering Page and agree to all conditions stated therein *

Choice without description