Memorial 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 corners.

Contact Info

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

Using a different email or phone 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(s) *

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

Memorial Design

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?

Design Uploads

If our company has already created a rough draft for you and you want to use it, OR if you have your own sketch, please upload the draft/sketch you would like to use below. You can upload multiple files. If not, and you would like our artists to help design your rough draft, skip this by clicking NEXT below.

Customer Supplied Uploads

Cemetery Info

Cemetery Name *

Cemetery Phone *

Cemetery Street Address *

Cemetery City *

Cemetery State *

Cemetery Zip Code *

Click "Submit" below to send us the info, and the agreement for your order will be sent over for you to authorize.