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Cemetery Memorial Wall - Plaque Order Form

Please use this form to submit an order for a bronze plaque to be installed on the Cemetery Memorial Wall. The plaques are 4in x 6in and include your loved one’s name and life dates. After we receive your order and payment, a proof of the plaque will be sent to you for final approval before it goes to production. Purchasers will also be notified of when the plaque will be installed.

Plaque Fees

Resident: $500 plus HST

Non-Resident: $750 plus HST

Purchaser's First Name

Purchaser's Last Name

Purchaser's Address

Purchaser's Phone Number

Purchaser's Email Address

Is the purchaser a resident of the City of Dryden?

Non-Resident

Resident

Full name to be displayed on the plaque:

Year of birth and death to be displayed on the plaque:

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Cemetery Memorial Wall - Plaque Order Form

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