South West Middlesex Crematorium Board

APPLICATION FOR CHILDREN'S GARDEN MEMORIAL SEAT

Terms and conditions

I N   L O V I N G   M E M O R Y  O F

Year (birth OR death)

Epithaph (maximum 25 characters - including spaces )

Details of person making this application (BLOCK LETTERS PLEASE):

Full name
Title
Address
 
Contact telephone number (in case of queries)
Email address

 

Signed  
Date

Memorial seat (lease for 5 years) £165.00

Cheques payable to SOUTH WEST MIDDLESEX CREMATORIUM BOARD
HOUNSLOW ROAD, HANWORTH, FELTHAM, MIDDLESEX, TW13 5JH
Tel. 020 8894 9001 enquiries@swmcrematorium.gov.uk

For office use
Receipt:
Date:
Plaque ordered: Location:
Date fixed(Expiry 5 years end of month):
 CR                     MID