"A Pathway to History" Brick Order Form

A "Pathway to History" Brick Order Form
Each brick costs $250 and includes the cost of engraving and installation.
Today's Date: *

Month Day Year
Date
Name: *
Address: *
City: *
State: *
Zip: *
Phone: *
Email :
Write your message below, line by line. Each brick may contain up to 3 lines of text . 14 characters per line including spaces. All text is centered.
Text to be engraved on your brick.
Line 1:
Line 2:
Line 3:
Example: I LOVE EPHRAIM
The Ephraim Historical Foundation reserves the right to edit content, or to refuse messages contrary to our mission. We will make efforts to contact you.
Thank you for your order!
Ephraim Historical Foundation 3060 Anderson Lane, PO Box 165 Ephraim, Wisconsin 54211 (920) 854-9688 www.ephraim.org
Should be Empty:

A "Pathway to History" Brick Order Form