Memorial Plaque Order Form

Memorial Plaque Order Form
Please complete this form regardless of payment method and forward it by mail or email as an attachment after printing it.( include payment along with the order form if not paying online) to::
Bowen Island Memorial Garden Society
c/o V. Hayden, 205-20894 57 Avenue
Langley, B.C. V3A 8M7

Each plaque cost $125.00 Canadian Funds. Payable by Cheque, Postal Money Order, International Bank Draft to the above address or by Interac e-Transfer. The Email address for eTransfer is bimgarden@shaw.ca (You may also attach the order form in a pdf or .jpeg format to the email)

One Plaque $125.00

Contact us at 604-539-6240 or by Email if you require additional information or assistance. Click Print This Page after completing the form up to the Signature Block

Name on Plaque:
Date Of Birth:
Date of Death:
Name Of Donor
Address
City
Province/State
Postal/Zip Code
Phone Number
Email Address
Your Comments
Signature	__________________________________________