Single and Companion Bronze Monument Order Form

Please enter the name(s) of the memorial you would like us to match and how close they are buried to the new deceased.

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(ALL INFORMATION BELOW IS FOR A SECOND ORDER FORM)

 Type of Bronze Marker
Single Bronze (24" x 14")
Companion Bronze (44" x 14")

Catalog Number: --- SIN-101 SIN-102 SIN-103 SIN-104 SIN-105 SIN-106 SIN-107 SIN-108 SIN-109 SIN-110 SIN-111 SIN-112 DBL-101 DBL-102 DBL-103 DBL-104 DBL-105 DBL-106 DBL-107 DBL-108 DBL-109 DBL-110 DBL-111 DBL-112 View Catalog Numbers^*

*SIN-101 for a single bronze and DBL-101 for a double bronze are our most traditional and most reasonably priced bronze memorials. As these gold bevel borders have no pockets, they also hold the least amount of dirt and are the easiest to maintain in the cemetery. However, any border design is permitted so choose the one you prefer.

Full name of deceased*
Please include middle name or initial if applicable


Date of birth*
Please include full date of birth unless you prefer only year of birth
Year: --- 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Month: --- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day: --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Date of Death*
Please include full date of death unless you prefer only year of death
Year: --- 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 Month: --- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day: --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Phrase of Endearment  
i.e. Beloved, loving, devoted or cherished husband, father, grandfather, brother, etc.


Additional Epitaphs or Other Descriptives
(View Examples of Epitaphs)
Epitaphs or other descriptives can be added to personalize your memorial further. If you are unsure, one can be added later.


Hebrew Name
(If you have your wedding Ketubah or the Hebrew name
written out, you can attach the document at the bottom of this form.)
Traditionally, the deceased Hebrew name and their father's Hebrew name is inscribed on the memorial. The deceased mother's name can be used as well if you choose. Please spell phonetically below.   If you are unsure of the Hebrew information, kindly indicate the rabbi who officiated at the funeral.  They usually keep a record of the deceased Hebrew name that we can obtain.  Another source for Hebrew names is from ones wedding Katubah.


What emblem would you like?
     Click to view Bronze Emblems
Emblems are optional and can be placed anywhere on the memorial

• Star of David
• Candleabra
• Eternal Flame
• Ten Commandments
• Holocaust Survivor
• Levite Pitcher
• Cohanim Hands
• Jewish War Veterans
• Eternal Flame
• Latin Cross
• Crucifix
• Cross & Open Book
• Praying Hands
• Holy Bible
• Eastern Star
• Masonic Blue Lodge
• Blessed Virgin Mary
• None
• Other:

Cemetery Name, Lot and section
Please include the name of cemetery, lot, section and grave number if available. If unknown, we can obtain it later.


Cemetery City & State


Does this memorial need to match any other family currently buried at the cemetery?
Yes

Unveiling Date
We usually like to allow 3 months to prepare and install the memorial. If you already have an unveiling date or time frame in mind, please indicate it below so we can schedule production and notify the cemetery accordingly.


Special Instructions
Please let us if you would like us to contact you prior to preparing the proof or if you have any other special requests

(End of Second Order Form)

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