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 $: ___________

 

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.