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 | $1,500 | $1,350 | |
| 12″ x 8″ Plaque | $1,000 | $900 | |
| 8″ x 8″ Plaque* Sold Out | $800 | $720 | |
| Add Picture in Picture | $50 | - |
*Please note the plaque mounting locations for the 8×8 plaques are extremely limited and will be mounted at, or near, the bottom of the walls.
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: | Visa Master 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: |
