Memorial Plaque Order Form - Form - B'nai Zion Congregation

Memorial Plaque Order Form

Having a Memorial Plaque ensures that your loved one will be remembered forever at B’nai Zion.
The Memorial light by the plaque will be lit the week of the Yahrzeit and at all Yizkor services.
The name of your loved one will be read for each Yahrzeit
and Kaddish will be recited for the Yahrzeit each year.

For your convenience, use this online form to pay directly.
If you prefer to submit a paper copy of the form, click HERE for the printable pdf version.

Date Submitted

Please install the plaque by: (Date)

Is there a specific date deadline for the plaque to be installed, for example a Yahrzeit or Yizkor? Leave blank if there is no deadline.
You will be notified when the plaque is installed even if you do not specify a deadline.
Note: It will take 6-8 weeks for the plaque to arrive at B'nai Zion.

INSCRIPTION: Name and date(s) for the plaque. Traditionally at B'nai Zion the name of the deceased with a birth date (bottom left) and death date (bottom right) are included. The secular or Hebrew dates can be used - and if requested, the Hebrew dates could be written in Hebrew.

(The engraver will arrange proper spacing.)

TOP LINE OF PLAQUE: Name of Deceased (The engraver will arrange proper spacing.)

Name of Deceased for Plaque:

Be careful to spell the name exactly as it should appear on the plaque.

Font Language

Write the Name with English LettersWrite the Name with Hebrew Letters

BOTTOM LEFT OF PLAQUE:

Traditionally this is used for birthday of deceased, but can be an alternate date.

(The engraver will arrange proper spacing.)

Date Information

Specify date for left bottom of plaque.
Please include month, day, and year.

Date Font

Write the Date with English LettersWrite the Date with Hebrew Letters

Secular or Hebrew Date

Secular DateHebrew Date SubmittedHebrew Date B'nai Zion Provides

Left Bottom of Plaque

BirthdayOther (specify in next field)

Other (Not Birthday)

If not birthday, please explain

BOTTOM RIGHT OF PLAQUE:
Traditionally this is used for death date of deceased, but can be an alternate date.
(The engraver will arrange proper spacing.)

Right Date Information

Specify date for right bottom of plaque.
Please include month, day, and year.

Date Font

Write the Date with English LettersWrite the Date with Hebrew Letters

Secular or Hebrew Date

Secular DateHebrew Date SubmittedHebrew Date B'nai Zion Provides

Right Bottom of Plaque

Death DateOther (specify in next field)

Other (Not Death Date)

If not death date, please explain

CONTACT INFORMATION:
Provide details about who to contact about plaque.

First name of person submitting the form

Last name of person submitting the form

Email for person submitting the form

Cell phone of person submitting the form

PAYMENT INFORMATION:
Details about the donation payment for the plaque.
Payment options on next page.

There is a minimum $500 donation per plaque,
which must be received by B’nai Zion
before the order will be submitted to the engraver.
Fill in amount of donation below (not less than $500):

Donation Amount: