Baptism Plaque Order Form

Fill out the form below and press the submit button only once at the bottom of this page.  Next pay for the item(s) by clicking on the "Buy Now" button under the price of the item at right.

Customer Name:

Street Address:

City:

State:

Zip:

Phone:

E-mail Address

$59.95

Buy Now

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PLAQUE INFORMATION

Childs Name:

Special Instructions:

Thank you for your order

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Baptised by:

Baptism Date:

Confirmed by:

Confirmation date:

Location:

Quantity: