Plaque Request Form

REQUEST TO PLACE A PLAQUE ON THE ST. MARK'S MEMORIAL WALL

4" X 6" Plaque
Saying:
In Loving Memory of _______
Birth year - Deceased Year

(Submit this completed form with payment)

NOTE: *Plaque will not be created until
full payment has been received.

As soon as the plaque is created, you will be contacted by the church to arrange a time and procedure for the placement of the plaque. If you have questions, please contact the church office.

Name of Requestor

Address of Requestor

Email of Requestor

This address will receive a confirmation email

Phone of Requestor

Plaque Sponsored by Name(s)

Name of Person to be Honored

Date of Birth

Date Deceased

Payment $295.00

Make Check Payable to: St. Mark's UMC Memo "Plaque"

Pay by Check Check Mailed to Church Check Hand Delivered

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Plaque Request Form

Description

Please Fix the Following