"Pathway to History" Brick Order Form
Each brick costs $250.
This includes the cost of engraving, pick-up, and installation.
Today's Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email :
myname@example.com
Name:
Address:
City:
State:
Zip:
Phone:
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
Submit (You'll be directed to Paypal securely)
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