Print, then Mail this form to:
 

GeneSaver
125 Hawthorne Village Rd.
Nashua  NH  03062

TEL: (603) 897-0220

When mailing this form, please enclose payment by check or money order.
E-mail any questions or comments to contact@GeneSaver.com

___  GENEALOGIST's Information Packet:

GeneSaver flyer
Seven Reasons to Save DNA brochure
Illustrations of custom-engraved containers
Sample prices
Ancillary services -- optional DNA analysis


_______________________________________________________

___  FUNERAL DIRECTOR's Kit:

How to use GeneSaver services
Authorization form
Order form for containers
Pre-need and funeral literature for the funeral home
Wholesale price list for containers, plus illustrations and container identification codes

___  Seven Reasons to Save DNA brochure
___  Brochure about GeneSaver DNA Preservation Services
___  Collection kits for the recently deceased. (No charge.)
___  Pre-need literature
___  Placard:  GENESAVER DNA SERVICES AVAILABLE
 

 Contact Person: _________________________________________
                     Title: _________________________________________
      Organization: _________________________________________
                 E-mail: _________________________________________
          Telephone: ____________  Ext. _________

  Street Address: _________________________________________
                     City: _________________________________________
  State/Province: __________________
ZIP/Postal code: __________________

Notes: