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D Shop LABMED Bereavement Certificate Worksheet Instructions: Please fill out the following sections completely. We will custom print each certificate using the information you provide. The donor section should contain information about you. In the Recipient Section, please provide information about the individual who is to receive the certificate. Should you have questions regarding formatting or information placement, please see the Bereavement Certificates image or e-mail Heather Bowden. Bereavement Certificates can be issued in any amount (over $5). To add a listing to the Paw Prints On Our Hearts page, select the option below and enter the name and dates as you'd like them to appear. You may also add a short dedication. If you would like for your Paw Print to link to a picture, a longer story or an external URL, please contact Heather Bowden for more information. Your listing will stay on the page for one year. You may list any pet on the Paw Prints On Our Hearts page and if you prefer to list your pet without getting a certificate, please let us know in the comments section. Information about the Donor: Contact Name: Street Address: City: State: Postal/Zip Code: Country: E-mail: Payment Method? I will send a Check to the address provided below; I will send a Money Order to the address provided below; I will use PayPal via the secure shopping cart payment form. Bereavement Certificate Recipient: Name (to Appear on Certificate): Street Address: City: State: Postal/Zip Code: Amount: E-mail: Donation in Memory of: Donation Made in Name of a Pet or Individual? pet individual Comments? The information provided in the Bereavement Certificate Section will be used to create and send a custom printed certificate to the above named individual(s). A formal donation letter will be sent to you utilizing the contact information you provided in the Donator Section. This donation letter will include the donation date, amount donated, and our Federal Tax Number. Please remember that all donations are tax-deductible and are very much appreciated. If you would like to include a personalized phrase, please feel free to do so in the Comments box in the section above. I would like to include the following on the: Paw Prints On Our Hearts Page Name: Date of Birth: Date of Loss: Dedication: To complete your request: Please fill out this form completely, including your e-mail address. The requested information you provided in the donor information section will allow us to contact you in the event of questions concerning your certificate order. After you submit the above information, you will need to provide payment information. Please follow the link at the bottom of the Bereavement Form Results page to complete the donation process. Should you prefer to make your donation using PayPal, we have provided a direct link via our secure shopping cart to process your donation. You do not need to have a PayPal account to pay using PayPal. If you wish to pay by check or money order, when your form is complete, please submit it (you may wish to print a copy for your records) and mail a copy, along with your check or money order, payable to LABMED, to: LABMED, Inc. 3941 Legacy Drive, Suite 204, #A115 Plano, TX  75023 When your donation is received we will custom print and ship your certificate. If you have any questions, please contact us at 972-208-2470.

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