Form to be completed by residents wishing to make an enquiry related to memorial benches.

Name *

Applicant Address *

Contact Number *

Email Address *

What type of memorial service would you like to purchase? *

Memorial Bench
Recasting of Plaque
Extension of Lease Agreement

Type of Memorial Bench *

Use What3Words Website to select a location

Visit the What3Words website to select a location for your memorial bench. Write the three words for your chosen location in the box for the next question.

Preferred Bench Location *

Memorial Plaque Name *

Memorial Plaque Message *

Recasting of Plaque Name *

Recasting of Plaque Message *

Extension of Existing Lease Agreement Number *

Memorial Bench Enquiry Form

Customer Contact Details

Use What3Words Website to select a location