Melanated Memorial Order Form

Directions:

Please complete the form below. You will receive a rendering via email for approval, before your memorial is produced, along with an invoice. No memorial will be ordered unless paid for in full. Once payment is received, your memorial will be ready for delivery in 4-8 weeks. Uprights may take 16-20 weeks. We currently only deliver to the Chicago/NW Indiana area only. Additional charges will apply for shipped memorials.
Memorial Color*
*Vase is not included unless specified. All sizes are in inches.
Memorial Design
Name of Deceased*
Date of Birth*

MonthDayYear
Date
Date of Death*

MonthDayYear
Date
Sentiment/Memory Phrase
Please limit to 35 characters.
Your Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Name of Cemetery
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Once your order has been submitted, the designer assigned to you will contact you directly with your invoice/quote. Once your deposit of $100 is received, you will receive a rendering of your memorial for your final approval.

If you have questions or are looking for a custom item, please call us at 877-840-2050 or email sales@licmemorials.com.
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