Customer Form
Bronze Package

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

Contact Info

Important: You MUST use the same 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 delay the process, so be sure to check the spelling on your email below.

First Name *

Last Name *

Phone *

Email *

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

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

Custom Phrase

You can add a custom phrase below up to 30 characters. If you do not wish to add a phrase, leave this box empty.

Added Phrase

Cemetery Info

Cemetery Name *

Cemetery Phone *

Cemetery Street Address *

Cemetery City *

Cemetery State *

Cemetery Zip Code *

Photo
Acknowledgement

Acknowledgement *

I acknowledge that pictures taken of my purchased, completed memorial by Stoltz Memorials LLC are the rights of Stoltz Memorials LLC 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 unless otherwise noted by Stoltz Memorials at the time of ordering, 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 submitted the cemetery fee and all paperwork to the cemetery. I also understand that this fee will have to be remitted to Stoltz Memorials prior to my memorial being installed.

Account Balance
Acknowledgement

Account Balance Acknowledgement *

I understand that any account balances will have to be paid prior to my memorial being transported to the cemetery and installed. Any account balances are due once the engraving has been completed in the production warehouse and NOT when the cemetery is ready for the memorial UNLESS on a predetermined monthly payment plan. Account balances that are not paid within 14 days of being engraved in the warehouse are subject to a $200 late fee.

Future Engraving
Acknowledgement

Future Engraving Acknowledgement *

I acknowledge and agree that any future engraving of the memorial, whether performed by Stoltz Memorials or a third party, is not included in this purchase and would be an additional charge in the future. This includes any names and/or final passing dates that may need to be added to the memorial in the future.

Click "Submit" below to send us the info, and we will begin to coordinate with your cemetery so that we can begin the process of creating your memorial.