Consumer Online Order Form



Name/Company:	P.O. #:
Street Address: *
City: *	State/Province: *
Zip or Postal Code: *	Day Time Phone:
E-Mail Address:	Fax:


Same as billing
Name/Company:
Street Address:
City:	State/Province:
Zip or Postal Code:	Day Time Phone:
E-Mail Address:	Fax:

How To Order:

1.) Pricing: $750 each (or $799 with 250-cubic internal urn for cremated remains). This price includes a custom 7 1/2" (W) x 5" (H) bronze plaque.

3.) Shipping: Memorial rocks are normally shipped via FedEx Ground- Pacific States $42 ea., Mtn. $45 ea., Central $48 ea., and Eastern
$52 ea. Contact us about orders to Hawaii,
Puerto Rico or internationally.

2.) Plaque Text: Once a memorial rock model has been chosen, you should prepare up to 10 lines of text with as many as 46 characters per line for the bronze plaque and type it into the field at bottom (each letter, number, space and punctuation is a character that should be counted in this per-line total).

Shipping Costs Map

4.) Payment: Full payment is required with the order. Add 7.25% sales tax for Calif. in-state orders.

5.) Order Time: Approx. 20-25 business days.

3.) Plaque Proof: Do you want to proof the plaque?

Yes, I want to proof the plaque

Fax To:

E-mail To:

No, I don't need a proof.

MODEL	DIMENSION	WITH URN?	COLOR CHOICE	QTY.	AMOUNT
CMR1	21" (W) X 32" (L) X 11" (H)
CMR2	27" (W) X 27 " (L) X 11" (H)
CMR3	26" (W) X 36" (L) X 8" (H)
CMR4	22" (W) X 28" (L) X 10" (H)
CMR5	21" (W) X 26" (L) X 12" (H)
CMR6	23" (W) X 28" (L) X 11" (H)
CMR9	29" (W) X 22" (L) X 11" (H)
CMR10	30" (W) X 20" (L) X 10" (H)
Subtotal:					$
Shipping: (See "Time Zone" Above )					$
(CA Residents Add 7.25%) Taxes: Calculate Your Tax					$
Total:					$

Plaque Text

The standard plaque can feature a choice of up to 10 lines of text with as many as 46
characters per line (typically a name, date of birth-death, and special verse or quote).
It's not necessary that all lines be used if less text is desired on the plaque.
Customers should be aware of the maximum number of characters per line (each letter, number, space and punctuation is a character that should be counted in this per-line total).
The more characters and words on each line, the more the individual characters must be reduced in size to fit the final layout.



Amex Visa Master Card Check (See instructions below for mailing address)
Credit Card Number:
Billing Street Address:
Zip Code:	Card Expiration: Month Year
• 3-Digit CVV Code (For security, provide the last 3 numbers on the reverse of the card or the 4-number code found on the right or left-side of the front of the AMEX card):

* All checks or money orders should be mailed to:	Valley Monuments, Inc. 630 E. Wooley Road Oxnard, CA 93030