NSVH Pet Memorial Plaque Order Form

Style I Style II Style III

Text Only Small Picture Large Picture
Up to 9 lines of text Up to 5 lines of text Up to 2 lines of text

All plaques are 6 x 6 and are made of black granite

All plaques are $125, which includes engraving and mounting on the memorial wall

Name: ______________________________________________________________________

Phone: __________________________ Email: ______________________________________

Desired Text (please print clearly)

Line 1 All Styles

Line 2 All Styles

Line 3 Style I & II

Line 4 Style I & II

Line 5 Style I & II

Line 6 Style I only

Line 7 Style I only

Line 8 Style I only

Line 9 Style I only

Photograph: Please submit a high resolution jpeg photograph to myvet@nsvh.com

If you do not have a digital copy, please bring a picture to NSVH and we will scan it and return the
picture to you.

If you have any special requests, please note them on the back of this page.

For office use: Payment Received Digital Photo Submitted Print Photo Submitted ( returned)