Buddy’s Place Plaque Information Form

(PLEASE PRINT)

 

Name               __________________________________________

Address           __________________________________________

                         __________________________________________

Phone / e-mail __________________________________________

 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _  

_______________

(PET’S NAME)

____________  -  ____________

 (BIRTH YEAR)     (DEATH YEAR)   

___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________

 ___________________________________________

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(MESSAGE--USE BACK IF NEEDED)

FOR SMALL (3.5”X6”) PLAQUES, PLEASE LIMIT TEXT FOR MESSAGE TO 220 CHARACTERS, NOT INCLUDING BLANKS.  PLEASE MAKE ONE CHECK PAYABLE TO SOUTHERN PINES ANIMAL SHELTER FOR $25 FOR THE DONATION AND ONE TO PLUM TROPHY SALES  FOR $16.05 TO COVER THE COST OF THE PLAQUE.

FOR LARGE (8”X10”) PLAQUES WITH PHOTO, PLEASE LIMIT TEXT FOR MESSAGE TO 500 CHARACTERS, NOT INCLUDING BLANKS.  PLEASE MAKE ONE CHECK PAYABLE TO SOUTHERN PINES ANIMAL SHELTER FOR $50 FOR THE DONATION AND ONE TO PLUM TROPHY SALES  FOR $80.25 TO COVER THE COST OF THE PLAQUE.  PHOTOS WILL BE RETURNED.

IF YOU ARE NOT SURE ABOUT BIRTH OR DEATH YEAR, WRITE UNKNOWN.

 MAIL CHECKS & COMPLETED FORM TO: 
BUDDY’S PLACE
P.O. BOX 17691
HATTIESBURG, MS  39404-7691

WHEN PLAQUES ARE COMPLETED, THEY WILL BE PICKED UP AND INSTALLED BY CURATOR OF BUDDY’S PLACE AND DONOR WILL BE NOTIFIED.  IF YOU HAVE ANY QUESTIONS, CALL KEVIN @ 601-268-1839.