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Memorial Wall Plaque Request Order Form

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- Please complete Memorial Wall Plaque Request Order form.
- Name of Donor REQUIRED Please fill out this field. Please enter valid data.
- Home Address REQUIRED Please fill out this field.
- Relationship to Deceased REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Memorial Wall Plaque Location REQUIRED St. Catherine's Memorial Garden St. Paul's Memorial Garden St. Peter's Memorial Garden Please fill out this field.
- View Sample of Wall Plaques before entering below details
  (Please use BLOCK LETTERS).
- Surname of Deceased REQUIRED Please fill out this field. Please enter valid data.
- Christian Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Death REQUIRED Please fill out this field. Please enter a date.
- Crucifix: REQUIRED Yes No Please fill out this field.
- If Yes, Blocked or Recessed. REQUIRED Please fill out this field. Please enter valid data.
- Verse (If required) REQUIRED Please fill out this field.
- Select Plaque Sample - Maximum lines - (6 lines St. Peter's) (5 lines St. Catherine's & St. Paul's) REQUIRED Please fill out this field.
- IMPORTANT NOTE: Additional Lines or Crosses will incur an additional cost
- Please note: The plaques cost $440 (Price increase effective 1st July 2022)
  Orders will not be confirmed with manufacturer, until payment has been received.
  
  Payment Method: Cash or EFT
  Bank Account: Holy Trinity Parish Church Account
  BSB: 083-347
  Account Number: 137245930
  Ref #: (Name of the deceased)
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