Memorial Plaque Order Form

Memorial Plaque Order Form

Contact Information

First Name

Last Name

Email

Are you a member at Holy Blossom Temple?

YesNo

I would like to order the following:

Memorial Plaque for $600Reserve a space for a future Memorial Plaque for $90

Memorial Plaque Details

How many Memorial Plaques would you like to order?

1: Memorial Plaque

Name for the Memorial Plaque:

English Date of Death:

Hebrew Date of Death

KnownUnknown

Hebrew Date of Death:

Time of Death

Before SunsetAfter Sunset

2: Memorial Plaque

Name for the Memorial Plaque:

English Date of Death:

Hebrew Date of Death

KnownUnknown

Hebrew Date of Death:

Time of Death

Before SunsetAfter Sunset

3: Memorial Plaque

Name for the Memorial Plaque:

English Date of Death:

Hebrew Date of Death

KnownUnknown

Hebrew Date of Death:

Time of Death

Before SunsetAfter Sunset

4: Memorial Plaque

Name for the Memorial Plaque:

English Date of Death:

Hebrew Date of Death

KnownUnknown

Hebrew Date of Death:

Time of Death

Before SunsetAfter Sunset

It is my understanding that a light will be kindled and the name of my beloved one read at the Sabbath Services following the above date each year, and at the appropriate Daily Service. The Memorial Plaque will also be lit at all Yizkor services.

Reserve a Memorial Plaque

How many Memorial Plaques would you like to reserve?

Reservation Details

1: Memorial Plaque for:

2: Memorial Plaque for:

3: Memorial Plaque for:

4: Memorial Plaque for:

Donation Information

Total Cost

$

CDN

Payment Method

Cheque

Please make cheque payable to Holy Blossom Temple
Please ensure it says "Memorial Plaque" in the note
Inscription will not proceed until payment has been received

Cheque can be mailed to:

Holy Blossom Temple ATTN: Cindy Zimmer

1950 Bathurst Street

Toronto, ON M5P 2K9

E-transfer

Please note the following:

The HBT email address is payments@holyblossom.org
Please include "Your Name + Monument Plaque" in the e-transfer message details.

Credit Card Information

Please help us to offset credit card processing fees by contributing an additional 3%

YesNo

Adjusted Total

3%

$

Revised Total

$

First Name

Last Name

Billing Address

City

Province/State

Please Specify

Postal Code

Credit Card Number

Expiry Month

Expiry Year

Final Fee

Hidden Fields

Invoice Name

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Contact Information