Request for Anniversary Plaque

View a Sample Anniversary Plaque
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Name of Couple (as it will appear on the plaque):

Please check applicable box:

50th Wedding Anniversary
55th Wedding Anniversary
60th Wedding Anniversary
65th Wedding Anniversary
70th Wedding Anniversary
75th Wedding Anniversary

Wedding Date:

Year   Month   Day

Address of Couple (Mississauga Residents Only):

Name of Contact Person:

Address of Contact Person:

Contact Person Information:
Home Phone:
Work Phone:
Email Address:
Fax Number:
   

Date of any Special Celebration (party):

Year   Month   Day

Date Requested:

Year   Month   Day

Any special instructions/requests:


Please allow six weeks, you will be notified by phone to arrange for pickup.