Our Family, Our Friends

Application For Inscription

To have your loved one added to the wall, please fill out the form below and send a Cheque or Money Order for $150.00 to us at Lights on the Hill, PO Box 11304, Centenary Heights QLD 4350.

You can also pay via direct deposit. Please use the surname on plaque for reference.

Lights on the Hill Trucking Memorial Incorporated
Not for profit Organisation

Bank – Heritage Bank
Account Name – Lights on the Hill Trucking Memorial Inc.
BSB – 638-070
Account No. – 10728082 (S21 for Heritage Bank users only)

Due to unforeseen issues with our website all plaque applications submitted online between 27th Feb 2017 & 27th May 2017 HAVE NOT been received. We understand that this will cause some problems for those people who have submitted their applications, and we do apologise for the inconvenience. As the problem has now been rectified we request that you simply re apply or please contact Juanita (lightsonthehill@live.com.au or phone 0401362960).  

All forms to be in before the 31st of July each year. Plaques will go on the wall at the official Memorial Day which is held on 1st Sunday of October. Only plaques ordered by Light on the Hill Trucking Memorial Inc. can be mounted on or around the wall. Lights on the Hill committee have the right to accept or reject any application at our discretion.

 
INSCRIPTION DETAILS
YOUR DETAILS
OTHER INFO

Please Note it is the responsibility of the Applicant to inform family members of this Inscription and only the contact person listed on this form will receive correspondence from Lights on the Hill Trucking Inc.

All care will be taken to see the names and dates are transmitted from this form to the plaque provider by Lights on the Hill Trucking Memorial Inc. In the event an error occurs by us we will rectify t hat error in due course at our expense. We however do not take any responsibility when the error is caused by incorrect information provided to us on this form, and the cost of rectifying the error will be at the cost of the applicant. Please tick the box below to acknowledge the Next of Kin has agreed and provides us with permission for the Inscriptee’s Name, and any relevant details, to appear on the Lights on the Hill Website and/ or Facebook Pages.

If the person submitting this Application is not the Ne xt of Kin of the Inscriptee , please provide details of the Next of Kin or Executor .

NEXT OF KIN
EXECUTOR/ADMINISTRATOR
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