Plaque Order Form
Choose Plaque Type
Individual Recognition or War Veterans Group Plaque
Multi-Name Recognition Plaque
Individual Recognition/War Veterans Group Plaques:
| Order | Size | Price | Tax Deductible Amount |
|---|---|---|---|
| 16″ x 8″ Plaque | $1,800 | $1,625 | |
| 12″ x 8″ Plaque | $1,200 | $1,050 | |
| 8″ x 8″ Plaque | $950 | $825 | |
| Add Picture in Picture | $50 | - |
Individual plaques allow for one picture. The picture in picture option provides one picture laid on top of another picture within the same Primary Photo
Veteran’s Information
| Veteran’s Full Name | ||
| Rank or Rate | ||
| Branch of Service | ||
| Conflict (WWII, Vietnam, etc.) | ||
| Medals, Ribbons, etc. (Optional) | ||
| Choice of Symbol (Choose One) | ||
| United States Flag | ||
| Branch of Service Insignia | ||
| Other/Symbol | ||
Veterans Military Experience
| The statement cannot exceed 25 words and must be directed to the veteran’s war record that “tells the story” of the veteran. Do not list what he/she thought of the service and his lineage (father, son, daughter, etc), but tell what he/she did in the service to our country. | ||
Donor’s Information
| Donor’s Full Name | ||
| Address | ||
| Address 2 | ||
| Apt No | ||
| City | ||
| State | ||
| Zip Code | ||
| Phone No | ||
| Alternate Phone No | ||
| Fax No | ||
| E-mail Address | ||
Payment Information
| Check (payment enclosed) | Make check payable to Mt. Soledad Memorial Association, Inc. | |
| Today’s Date | ||
| Charge My: | VisaMaster Card |
Card Number:
Expiration Date:
CVV No:
Click Here (explanation opens in new window)
Signature:___________________________________________________________________
Mail To or Fax
Mt. Soledad Memorial Association, Inc.
6437 Caminito Blythefield, Suite B
La Jolla, CA 92037
Fax: 858-459-2485
| Please tell us what prompted you to purchase a plaque: |
