Memory Box Order Form – Harvey Hext Trust

Step 1 of 4

Section 1 : Child's Details

We are a UK charity and only operate within the UK

Parent/Carer/Legal guardian Name *

In Memory of *

Age of Child *

Total number of siblings for this application (including step) *

IF YOU REQUIRE DIFFERENT DESIGNS PER SIBLINGS, PLEASE SUBMIT AN INDIVIDUAL APPLICATION PER DESIGN.

Referred by *

Organisation *

Family Name *

Date *

Section 2 : Design

WE CAN ONLY USE 25 IMAGES IN THE ENTIRE DESIGN.
We will use 25 photographs/images of your special design to create your very own personalised Memory Box * Please note that whilst we will do everything we can to make your memory box as personal as possible, some images are protected by copyright and so cannot be included in your design.

Top of Box

Click or drag files to this area to upload. You can upload up to 10 files.

Special requests, for example - Do you want a particular photo/image put on a specific side of the memory box? Is there any wording you would like included e.g name, date of birth, a phrase/sentence that means something special to you: Please detail below: **Remember to attach all photos/images to the email with your order form**

Top of Box Wording/Dates

Image layout (how would you like the images to appear on the top of the box?)

Front of Box

Click or drag files to this area to upload. You can upload up to 10 files.

Front of Box Wording

Image layout (how would you like the images to appear on the front of the box?)

Left of Box

Click or drag files to this area to upload. You can upload up to 10 files.

Left of Box Wording

Image layout (how would you like the images to appear on the left side of the box?)

Right of Box

Click or drag files to this area to upload. You can upload up to 10 files.

Right of Box Wording

Image layout (how would you like the images to appear on the right side of the box?)

Back of Box Wording

Back of Box

Click or drag files to this area to upload. You can upload up to 10 files.

Image layout (how would you like the images to appear on the box of the box?)

Number of Images attached:

Selected Value: 0

To ensure we have received all of your precious memories, please tell us how many images you are e-mailing to us . Please note that we can accomodate a total of 25 images. When considering where to place your images, the longer sides of the box can fit up to a maximum of 9 and the shorter sides 5

Google Drive or Dropbox link

If you would prefer to use Google Drive or Dropbox for us to access your images, please paste the link in the box provided. (please ensure we have assess permissions.

What theme would you like? e.g. Butterflies, Stars (copy)

Would you like to change the background colour? *

Would you like Harvey Bear? *

Additional Message or information

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