By sending this form, Chipman Funeral Home & Chipman Cremation Centre  will place a card in memory of your loved one. You will be responsible for remitting the donation to the designated charity. Please see our CHARITY LIST  for charitable organizations and their addresses. (To prevent us from receiving spam, please enter the letters in the image below before submitting this form).

In Memory Of (Deceased's Name):
Name of Charity:
Your Name(required):
Your Email Address(required):
Your Mailing Address:
Your Phone:
Your Message to the family:
Enter Security Image: