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BSG /7(&6721(GRANITE - MEMORIAL FORM Date:___________________

ORDER QUOTEYhKdt/d,^Wh>d/sZt/E'

LOCATION: COUNSELOR: _____________________________________________

FAMILY NAME: ___________________________________________

CONTRACT NUMBER: ______________________________________

COLOR: GRC Gray Jet Black GRC Mahogany Coral Blue Rubin Red Other:

QUANTITY ITEM         SIZE OF MEMORIAL:             CIRCLE ALL THAT APPLY FOR EACH ITEM:


Die                     X                   X         P2       P3        P5      Serp       Flat       Oval    Other: ____________ 
Base                     X                   X         PFT         2" PM         AP         BRP        Bevel Front
Slant                     X                   X         PF, Sawn Back BRP ‐     Serp     Flat      Oval
Bevel                     X                   X         PT, BRP       AP      ___" Drop       ____" Margin
Flush                     X                   X         PT, BRP         PT, SS     PT, Bevel Edge
Bench GRC #
Vases Inverted Taper:               x            x Round Turned :                 x                x Bronze Vase:     
Etching Yes  No

Duplicate:  Rubbing and Photo Attached  ‐ Yes No
Special Notes:

Inscription:           V‐SUNK          U‐SUNK      DESIGNER'S CHOICE OTHER


Rough Sketch/Lettering of Memorial: Design #:

  

Please provide any special requests in writing:

FAX TO 262‐367‐5249 EMAIL  kbrue@grcgranite.com QUESTIONS  800‐777‐9979

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