Memorial Plaque Order Form

Home
Donate

Home
Donate

Purchaser Information

First Name of Purchaser

Last Name of Purchaser

Address

City

State

Zip Code

Plaque Information

How many plaques are you purchasing ($750)?

Name of Deceased

TYPE EXACTLY AS YOU WISH THE NAME TO APPEAR ON PLAQUE

Date of Birth

Date Format: Month Date, Year

Date of Death

Date Format: Month Date, Year

Name of Deceased

TYPE EXACTLY AS YOU WISH THE NAME TO APPEAR ON PLAQUE

Date of Birth

Date Format: Month Date, Year

Date of Death

Date Format: Month Date, Year

Name of Deceased

TYPE EXACTLY AS YOU WISH THE NAME TO APPEAR ON PLAQUE

Date of Birth

Date Format: Month Date, Year

Date of Death

Date Format: Month Date, Year

Name of Deceased

TYPE EXACTLY AS YOU WISH THE NAME TO APPEAR ON PLAQUE

Date of Birth

Date Format: Month Date, Year

Date of Death

Date Format: Month Date, Year

Name of Deceased

TYPE EXACTLY AS YOU WISH THE NAME TO APPEAR ON PLAQUE

Special Instructions

If you have any requests or special instructions on placement, please note that here.

Total

Sat, July 27 2024
21 Tammuz 5784

ShulCloud Login

Log into your ShulCloud account using your email on file with OST. If this is the first time logging in, enter the password of your choice. If you have questions or need assistance, call the office at 757-625-4295.

Sat, July 27 2024 21 Tammuz 5784