Memorial Plaques

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 $: ___________




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.