Customer Form

Please fill out the form in its entirety only one time, and be sure all info is accurate and spelling is correct.

You can navigate the form using the "next" and "back" arrows in the bottom righthand corner.

Information you will need to fill out this form:

Names & dates to be engraved
Cemetery name, address, & phone #
Orientation (left and right) of names (if companion memorial)
Any artwork/design ideas for our artists (If you want our art team to create your rough draft)

Contact Info

Important: You MUST use the same name & email below that we have on file for your order - it is the same email that this form was sent to.

Using a different email will cause your order to stay in "pending" in our system and will significantly delay the process, so be sure to check the spelling on your email below.

First Name *

Last Name *

Phone *

Email *

Your
Mailing Address

Address *

City *

State *

Zip code *

Name(s) & Dates
To Be Engraved

Family Name *

If you purchased a
single memorial with only 1 name:

Complete boxes under "Left Side Name",
& leave remaining boxes blank.

If you purchased a
companion memorial with 2 or more names:

Complete all boxes. We will engrave the names on the right and left how you enter them below, so if position of the names is important to you, please confirm these with your cemetery prior to submitting this form.

Left Side Name

First Name (Left Side) *

Middle Name Or Initial (Left Side)

Birthdate (Left Side) *

Passing Date (Left Side) - Type "Date Line" If Still Living *

Right Side Name (If Applicable)

First Name (Right Side)

Middle Name Or Initial (Right Side)

Birthdate (Right Side)

Passing Date (Right Side) - Type "Date Line" If Still Living

Anniversary Date

If you purchased a companion memorial (2 names on the stone), and you would like to add an anniversary date in wedding rings to the stone, use the box below. If not, leave blank.

Anniversary Date (Companion Memorials Only)

Additional Names

If you have additional names being added to the memorial other than the names listed above, please add the additional names and dates in the box below with desired position on the stone. If not, leave blank.

Additional Names

Rough Draft
Art Design

Let us know below how you would like
to complete your rough draft memorial design

Art Design Preference *

Your artists can create a memorial draft for me to view

I would like to schedule a Zoom appointment and create a design with a team member over the computer

Stoltz Memorials has already issued me a rough draft

I have my own sketch/image I would like Stoltz Memorials to use to create a rough draft

Upload Your
Memorial Sketch

Customer Supplied Rough Draft Sketch

Art Ideas
For Our Artists

For the custom artwork, we can engrave a wide variety of items. Please list any ideas you would like to see on your rough draft below.

The more ideas you give here and the more specific you are, the more our art department has to work with. If you do not wish to add a second idea or a phrase, please leave blank.

Art Idea #1

Art Idea #2 (If needed)

Additional Phrase

You can add a phrase or verse to your memorial if you wish. If not, leave blank.

Added Phrase

Anything Else We Need to Know?

Cemetery
Information

Cemetery Name *

Cemetery Phone *

Cemetery Street Address *

Cemetery City *

Cemetery State *

Cemetery Zip Code *

Photo
Acknowledgement

Photo Acknowledgement *

I acknowledge that pictures taken of my purchased, completed memorial by Stoltz Memorials are the rights of Stoltz Memorials and may be subject to use in marketing material and promotions, including, but not limited to, print media, digital media, and examples for future customers.

Cemetery Fee
Acknowledgement

Cemetery Fee Acknowledgement *

I understand that my cemetery fee is not included with my purchase, and that I will be invoiced for my cemetery fee + a $25 admin & processing fee after Stoltz Memorials has remitted my cemetery fee and all paperwork to my cemetery. I also understand that this fee will have to be reimbursed to Stoltz Memorials prior to my memorial being moved to production.

Account Balance
Acknowledgement

Account Balance Acknowledgement *

I understand that unless I am on a third party monthly payment plan, any account balances, including cemetery fees, are due once a final proof of my memorial has been created and sent to me to view. I understand that my memorial will not be placed into production until all account balances have been paid.

Future Services
Acknowledgement

Future Services Acknowledgement *

I acknowledge that this purchase does not include any future services or work after the memorial has been installed, which may include, but is not limited to, any on-site memorial engraving, including adding any final death dates, or opening up a cremation memorial to inter cremains/urns. Any future services that will take place after installation would be an additional charge and are not included in this purchase.

Installation Scheduling Acknowledgement

Installation Scheduling Acknowledgement *

Due to varying factors such as weather conditions, traffic, and cemetery schedules, I acknowledge that Stoltz Memorials cannot guarantee specific times for memorial installations, nor can Stoltz Memorials schedule installations specifically to accommodate family presence at the site at time of installation. Installation scheduling must remain flexible to efficiently manage unforeseen delays and maintain quality and prompt service for all families.

Click "Submit" below to send us the info, and we will begin the process of helping you and your family create something special.