Memorial Tile Order Form Step One: Fill in your text below on the form. If this is a gift for someone, please provide the name and address of where the tile replica should be mailed. Step Two: Attach a photo using the easy upload tool below. If you do not have a photo to upload, please mail one to our Orlando business office - 2727 Conroy Rd. Orlando, FL 32839. Step Three: After completing the form, please fill out the payment portion at the bottom. Memorial Tiles are $100.00. If you have any questions or concerns, please email Lauren Rease, at [email protected] Purchaser's First and Last Name*Purchaser's Mailing Address*Purchaser's Phone NumberPurchaser's Email Address Is this a gift for someone?* Yes No If yes, please fill out the portion of the form below. If no, please proceed to the message on the tile.Gift Recipients First and Last NameIf your memorial tile is a gift for someone, please fill out their name here.Gift Recipients Mailing AddressGift Recipients Phone NumberGift Recipients Email AddressMemorial Tile Message*This is the message that will appear on your memorial tile.Photo Upload* Drop files here or Accepted file types: jpg, png, pdf. Please upload the picture you would like to have on your tile. Memorial Tile Cost* Price: $100.00 Total $0.00 Credit Card Payment Information* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Please make your payment for your memorial tile here. Memorial tiles are $100.