By sending this form, Chipman Funeral Home will place a card in memory of the deceased. 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):
* Your Name:
* Your Mailing Address:
* Your Phone:
* Your Email address:
* Name of Charity:
* Your Message to the Family:
* To submit this form, please enter the characters you see in the image: