Death Notice Summary Order Form

Payment Options

Cheques Make cheque payable to: A Memory Tree Limited Post with your cheque to: A Memory Tree Limited PO Box 4078, Timaru, 7910 New Zealand Internet Banking Make payment to: 06-0821-0518149-00 Reference: Deceased’s ID Number Email this form to: [email protected]

You must complete the following information

Your Details

Name:

Email:

Postal Address:

Phone:

Deceased’s Details ​

First Name:

Last Name:

ID Number:

Date of Death (if known):

You must select the relevant publications on next page Please select relevant publications

Ashburton Courier $9.90 Northern Advocate $9.90 $9.90 Northern News $9.90 $9.90 Northland Age $9.90 Bush Telegraph $9.90 NZ Herald $9.90 Central Hawkes Bay Mail $9.90 Oamaru Mail $9.90 Central Otago News $9.90 Optiki News $9.90 Coastal News $9.90 $9.90 Dannevirke News $9.90 Rotorua Weekender $9.90 Daily Post Rotorua $9.90 South Waikato News $9.90 Dannevirke News $9.90 Southland Times $9.90 Dominion Post $9.90 Stratford Press $9.90 Ensign $9.90 Sunday News $9.90 $9.90 Sunday Star Times $9.90 Star $9.90 $9.90 Hamilton News $9.90 Taumarunui Bulletin $9.90 Hastings Leader $9.90 Taupo Turangi Weekender $9.90 Havelock North Village $9.90 Te Awamutu Courier $9.90 Press Hawkes Bay Today $9.90 Te Puke Times $9.90 Herald on Sunday $9.90 $9.90 Guardian $9.90 Timaru Herald $9.90 Horowhenua Daily $9.90 Waihi Leader $9.90 Chronicle Kapiti News $9.90 Waikato News $9.90 Katikati Advertiser $9.90 $9.90 Manawatu Guardian $9.90 Waipa Post $9.90 $9.90 Wairarapa Times $9.90 $9.90 Wairoa Star $9.90 Matamata Chronicle $9.90 Wanaka News $9.90 Mountain Scene $9.90 $9.90 Napier Courier $9.90 Whanganui Med Week $9.90 Napier Mail $9.90 $9.90 Nelson Mail $9.90 PURCHASE TOTAL $ Cheque enclosed / Internet banking payment (delete one) ​