Memorial Plaque Order Form
Individual Yahrzeit plaque prices:
[ ] $360 each paid with the order
[ ] $300 each when multiple quantities are ordered at the same time
Please print clearly
Name of the deceased in English (First name & Last name):
Name of the deceased in Hebrew
Date of death in English:
Date of death in Hebrew:
Plaque ordered by: ________________________________________________________
Date of request: ___________________ Phone#: ______________________________
Total number of plaques ordered at this time:________ Check amount $: ___________
FOR OFFICE USE ONLY
Text cleared: _____________________________________________________________
Final approved actual text of plaque:
Please note that double plaques, alternative wordings and plaque placement need be discussed and cleared by the person in charge of the plaques project. In addition, Rabbi Shmidman is available for consultation on plaque wording.
Completed forms should be returned to the shul office.
