Name *

Address (street, city, state, zip) *

Your Email *

Name of Individual/Family to be Memorialized *

Preferred Dates (Please provide three options) *

Special Requests - Specific Songs; Ethnic, Religious or Patriotic Theme (*These cannot be guaranteed, but every effort will be made to fulfill these requests. We have many songs in our library and have the ability to customize the carillon for any occasion.)

Preferred Method of Billing *
Emailed InvoiceMailed Invoice

By checking this box, I acknowledge that if my chosen date corresponds to various events and/or movable holidays (such as Palm Sunday, Holy Thursday, Good Friday, Easter, Hannukah, Passover, Mother‘s Day, Father’s Day, Memorial Day, Labor Day, Thanksgiving, etc.) the song selection may be changed by Stella, LLC to meet the appropriateness of the occasion or holiday, but my memorial will be acknowledged and recognized.