Memorial Brick Order Form

Please complete this for exactly how you want your brick to look. Memorial bricks outline the scatter garden at Forever Home Cemetery.

• Each of the 3 lines can contain up to 13 characters. Commas, periods, and spaces count as a character.
• A memorial brick is $45. After you submit, you can pay online or mail a check.
• For more information, contact Marilyn Wheat at (217) 871-7853 or the office at (217) 737-4042.

Prefer to print and fill it out by hand? Download the PDF ↗

Your brick

Type each line exactly as you want it engraved. The boxes match the brick — 13 characters per line.

Line 1*

Line 2

Line 3

Purchaser

Purchaser's name*

Street address*

City

State

ZIP

Phone*

Email address*

Leave this field empty

🔒 Your information is private. It goes straight to Forever Home Cemetery for review — we never sell or share it.

Submit brick order