Texans for Equal Justice
Crime Victim Memorial Wall

Order Form
    Step One: Victim Information
      Name of Victim:
      Date of Birth:
      Date of Death:
      Offense cause of Death:
      County in which Offense Occurred:
      Your Relationship to the Victim:


    Step Two: Personal Information
      Name:
      Home Phone:
      Mailing Address:
      City:
      Zip Code: -
      *Your E-Mail Address:
      State you live in:



    Step Three: Comments
      Please use the comments section of this form and share about your loved one. It may be the special qualities that you love about the person he or she was - the contributions his or her life had on those around them or maybe a poem. TEJ's Crime Victim Memorial Wall Project is a tribute to the lives of the victims and a statement of commitment that they will never be forgotten.


    Step Four: Submit it
      Once you have completed out the form above, Simply click on the "Submit" Button below and your information will be submitted to us.

      I understand that submitting this information to Texans for Equal Justice constitutes your permission to post on our website the information you have provided to us above.

      I agree: