Contact Us Form | Memorial Bracelets | Victims of Terrorism and Military Killed in Action, Prisoner of War and Missing in Action Memorial Bracelets

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Why Wear

I lost my cousin, Lt. Cmdr. David L. Williams, in the attack on the Pentagon. I will wear this Memorial Bracelet proudly in his memory, so that he is never forgotten.

I choose Nicole Miller's name because I knew her and used to work with her, I didn't know she was on Flight 93 until last year.

I ordered the bracelet because Barbara Edwards (who was a victim on Flight 77) was a teacher at one of our local high schools.

To contact us, please complete and submit the form below.

First Name:

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Last Name:

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Address:

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Address 2:

City:

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State / Province / Region:

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Zip Code:

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Country:

Please select an item.*

Telephone:

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Email Address:

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Confirm Email Address:

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Relationship to Person:

Please select a Relationship.*

Reason for Contacting Us:

Request a person's name be added or information modified

Request a person's name be removed

Request a Supportive Message be added to the site

Obtain immediate family member discount pricing

Not completely satisfied with your bracelet

Return a Supportive Message Bracelet in new condition

Ask a question not in the FAQs or make a comment

Change or inquire about your order

Did not receive order within 10 days of receiving email that it shipped to civilian address or 60 days to a military APO/FPO address.

Ship an order outside of the United States to other than an FPO or APO

Order a bracelet that requires more than 30 characters on a line

To request a person's name be added or information modified, please complete the following:

Person's First Name:
Person's Last Name:
Military Rank:
Military Branch:
Age of the Person in Years:
Person's City of Residence:
State/Province/Region:
Country of Residence:
Event Name:
Event City:
State/Province/Region:
Date of Event (mm/dd/yyyy):
Please describe the reason for the Addition/Modification in detail:

To request a person's name be removed from the site, please complete the following:

Event Name:
Person's First Name:
Person's Last Name:
Home City:
Home State/Province/Region:
Date of Loss/Capture/Missing (mm/dd/yyyy):
Please describe the reason for the removal request in detail:

If you would like to add a Supportive Message to the site, please enter the message below:

Supportive Message: (30 Characters Max)

If you are an immediate family member of a person listed on this web site and would like to order a bracelet with his/her name and receive a discount, please complete the form below:

Type of Product:

Number of Icons:

Number of Products:

Enter the Name of the Person you will have
or had Engraved:

First Name
Middle Int.
Last Name

Choose the Event:

Describe in Detail your Relationship with the Person:

If you have already Placed an Order,
Enter Order ID Number
(Found on Your Order Confirmation Form)

If you are not satisfied with your bracelet for any reason, please describe the reason in detail below:

Reason:
Enter Order ID Number (found on your Order Confirmation):

If you would like to return a Supportive Message Bracelet in new condition, please describe the reason in detail below:

Reason:
Enter Order ID Number (found on your Order Confirmation):

If you have a general question not answered by a FAQ or a comment, please describe it in detail below:

Question/Comment:

If you would like to change or inquire about your order, please describe in detail the change you would like to make or question below:

Details:
Enter Order ID Number (found on your Order Confirmation):

If it has been 10 days since you received an email that your order was shipped to a civilian address or 60 days since to a military APO/FPO address, please enter your Order ID and any additional comments or questions below:

Details:
Enter Order ID Number (found on your Order Confirmation):

If you are shipping to an international address outside of the United States (other than an US APO or FPO), please enter the shipping address, the number of bracelets and the type of metal, and the method you would like to ship below:

Address 1 or Company Name:
Address 2:
City:
State/Province/Region:
ZIP/Postal Code:
Country:
Type of Product:
Number of Icons:
Number of Products:
Shipping Method: (UPS cannot deliver to a Post Office Box)

If you would like a customized message longer than 30 characters engraved on a product and you would like us to determine if we can engrave it, please enter your message and the product type and size below:

Engraving on Top Line:
Engraving on Middle Line:
Engraving on Bottom Line:
Type of Product:
Number of Icons:
Number of Products:
Product Size:

Enter Security Code Below:

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