SSGHS Photo Service Order Form

Your name (please print)____________________________________________
Your address_____________________________________________________
Email address_____________________________________________________
Name of cemetery (other subject)______________________________________
Location of cemetery (other subject)____________________________________
Cemetery office hours_______________________________________________

Ancestors names and approximate birth and death dates and gravesite location(s) 
or address of other location(s) that you want photographed:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Use additional sheet if necessary
__________________________________________________

I understand that will the fee for this service is $15.00/hour with a $40.00 minimum and that SSGHS will provide a 
quote and then complete the request upon receipt of your check.
I also understand that it could take four to six weeks to fill this order.

Your signature_____________________________________________   Date________________

Send request to:
SSGHS
/ Photo Service
3000 W. 170th Place
Hazel Crest, IL.  60429-1174
   

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