Memorial Card Order Form

Contact Name or Company

Phone

Ship to Address/Location: (add details if necessary)

Order Needed By Time & Date

NOTE - If custom order please upload the image or images below. If you have more than one image, please specify where images are to be placed on the memorial card. If you have any questions please contact our office.

Image 1

Image 2

Image 3

Qty

Order Item Code: (if multiple codes, note in spec. inst.)

Prayer / Poem

Loved One's Full Name

Loved One's Date of Birth

Loved One's Date of Passing

Type of Service:

Services Held at Funeral Service Celebration of Life Memorial Service Memorial Celebration

Funeral Mass Chapel Service

Clergyman Name

Service Day

Location of Service:

Service Date:

Service Time:

Type of Burial

Interment Entombment Inurnment Cremation

Cemetery/Mausoleum

Grave Number

Lot Number

Block Number

Section

Crypt Number

Tier Number

Mausoleum Section

LED Candle Order

LED Candle Qty

Special Instructions for this order: (please state if an order is for early morning in this box)