25 South Main Street Dover, Pa. 17315 Office 717-292-2621 Fax 717-292-7936
E-Mail: info@baughmanmemorials.com

Work Order #

Submitted By*

Enter your first and last name

Memorial Information

Name of Deceased*

First Middle Last

Date of Birth Month*

Date of Birth - Day*

Date of Birth - Year*

Date of Death Month*

Date of Death - Day*

Date of Death - Year*

List other names on memorial

Type of Burial*

Traditional Burial
Cremation

Style of Memorial*

Color of Memorial*

Color of Memorial, if other.

Inscription*

Year Only
Abbreviated Full Date
Full Date Spelled Out

Cemetery Information

Name of Cemetery

Address of Cemetery

Street Address City State

Section Number

Lot Number

Grave Number

Description of Location in Cemetery

Map (Image upload)

Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 128 MB.

Image2 (Image upload - optional)

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 128 MB.

optional image

Bill to: Customer Information

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Billing Phone*

Cell Number

Date Submitted*

Note: Completion of work is approximately 60 to 90 days weather permitting.

Comments

This field is for validation purposes and should be left unchanged.

Death Date Inscription Order

Memorial Information

Cemetery Information

Bill to: Customer Information

Dover Office

Red Lion Office

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