Wildrose Virtual Cemeteries
Public Memorial Order Form

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Order your memorial by selecting the check boxes for the following options. To see a sample of each of the four types of memorials, click on the picture.
Select one (1) of the four STYLES of MONUMENTS.
Public Style #1 Single	Public Style #2 Single
Public Style #3 Companion	Public Style #4 Companion
Please select one (1) of the available memorial COLORS.
Public Red	Public Swirl
Public Rose	Public Black
Public Gray	Public White
Name of person placing order:
Your e-mail address:
The Deceased's Full Name:
Date Born (mm/dd/yyyy):
Date Passed Away (mm/dd/yyyy):
Spouse's Full Name: For "Companion Style Monuments Only"
Date Born (mm/dd/yyyy): For "Companion Style Monuments Only"
Date Passed Away (mm/dd/yyyy): For "Companion Style Monuments Only"
Name of Cemetery Where Interred:
City and State of Cemetery:
Would you like to add a design on your marker? YES NO
Give a brief design description:
Would you like to add a portrait(s) of your loved one(s) on your memorial at a later date? We will contact you shortly if you answered "yes." YES NO
Would you like to add your loved one's obituary to your memorial at a later date? We will contact you shortly if you answered "yes." YES NO
Would you like to have an e-mail link to you from visitors viewing your memorial? YES NO

To place a brief saying on the cemetery marker, up to 10 words, write it here:

Please feel free to add a prayer, verse, poem, story, or other
words of rememberance about your lost loved one in the space below.

Your order is 100% SATISFACTION GUARANTEED. We live by the words, "The customer is always right!" If you are not completely satisfied with any aspect of your order, we will ensure that the necessary changes are completed in a timely manner to make you 100% satisfied. We won't be happy until you're happy!