REQUEST FORM
This information will help us determine how to best meet your needs. You may fill this out and submit it to us or just have the information available when you call us for an appointment.
Name:
Address:
:
City:
State:
Zip:
Phone:
Preferred time to call:
Do you have a cemetery lot?
choose one
yes
no
If yes, please list name of cemetery:
If yes, please list name of cemetery:
Address:
City:
State:
Sexton Name:
Phone:
Cemetery Section:
Lot Number:
Type of monument:
choose one
Slant
Bevel
Upright
Other
Single or Double:
choose one
Single
Double
Would you like to see any special emblems pertaining to hobbies, military, pets, etc on your monument? If so, please describe:
Do you have a granite choice picked out?
choose one
Yes
No
You might want to pick out 2 or 3 to compare prices:
Are you interested in putting the names of your children on the back of the monument? If so this would be an extra charge:
choose one
Yes
No
If you are purchasing an upright monument, you will need to decide if you want it to be 6 inches or 8 inches thick:
choose one
6 inches
8 inches
If you are purchasing an upright monument which style top do you want?
choose one
Straight across
Curved
Do you want your monument to be smooth and shiny all over or have the sides and top rough edges?
choose one
Smooth & Shiny
Sides & top rough edges
Use this space for additional information: