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2. VETERANS MEMORIAL WALL ORDER FORM
4. VETERANS NAME - INCLUDE RANK*
6. SERVICE BRANCH - on this line you can add a short quote *
8. SERVICE DATES OR BIRTH OR PASSING DATES (numerical)*
10. BUYERS Name
11. Email Address
13. Address
15. City
16. State
17. Zip Code
19. Phone Number
21. DATE PAID & FORM OF PAYMENT (INCLUDE CHECK #) *
23. INFORMATION TO PLACE ORDER

    If you would like to purchase a plaque for our Veterans Memorial Wall to honor

    or memorialize a family member or friend, please complete this link or visit Town Hall to pick up a form.  

    The cost is $50 per plaque. Checks should be made

    payable to “Town of Surfside Beach” and mailed to Town of Surfside Beach,

    Veterans Memorial, 210 US Highway 17 South, Surfside Beach, SC 29575 or you

    may drop your application and payment at Town Hall. Credit card payments can be made at Town Hall.  If you have any

    questions, please contact Tabitha Mull, 843.913.6359 or email

    tmull@surfsidebeach.org. An acknowledgment will be mailed at no

    additional charge when the plaque is installed. Note: No advertising

    (including business names) or personal statements are allowed.

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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

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