Request A Plaque | NC Veterans Memorial Pavilion

Memorial Wall Order Form

2"x7" Black Granite Panel

Purchaser's First name

Purchaser's Last name

Purchaser's Phone

Purchaser's Email

Purchaser's address

Country/Region

Address

City

Zip / Postal code

Veteran Full Name

Please fill in the name by Last Name, First Name.

Veteran Branch Served

Veteran Rank Served

Fixed price

$150

No changes will be allowed. Please submit one order form per name.

For multiple names, you must submit individual forms for each name. Thank you!

For more information please email: broadway27505@gmail.com

Would you like to include a story about them?

Would you like to include an image for their profile?

Image must be service image.

By submitting this story and/or photograph, you grant the NC Veterans Memorial Pavilion a non-exclusive, royalty-free, perpetual license to utilize, reproduce, and display the content. You acknowledge and agree that this content may be featured in our digital registry, promotional materials, and on our official social media channels to honor our veterans and promote the Memorial’s mission. You certify that you have the right to share this content and that it does not infringe upon any third-party rights.