Madison Valley Veterans' Memorial Order Form

Order Form
Eligibility: Veterans who have honorably served in peace or war,
resident or nonresident, living or deceased. Battles, dates and/or
units may also be commemorated. No orders accepted from May 31 - July 4.
Bricks to be dedicated July 4, 2012 at the Memorial in Ennis, Montana.
Newly dedicated bricks will be available to be reviewed on line, August 15, 2012.

Make tax-deductible
(Tax ID #68-0580264) Checks/Money Orders Payable:

Madison Valley Veterans' Memorial
P.O. Box 411 ~ Ennis, MT 59729

________________________ _______   __________________________
              First Name            MI                        Last Name
Personal Awards (PH or higher), or KIA if killed in action ______________

_______   __________________   ________________________________
   Rank      Branch of Service          Conflict (If Any), or Years served
and/or _______________________________________________________
          Battle/Date/Unit Categories (3 Lines, Max. 14 Chars. per line including spaces)
Example: Click Here and Note Battle/Date/Unit Categories here in red.

Donor's Name/Phone ___________________________________________

Place this brick with _______________________________

Quantity

Item/Description

Each

Total

_______________

Bench (Includes Miniature Cowboy,
8"x8" brick and 4"x8" brick)

$5,000.00

_______________

Story Plaque

$3,000.00

_______________

Miniature Cowboy

$1,200.00

_______________

___________

Brick 8"x8"

$1,000.00

___________

_______________

Brick 4"x8"

$100.00

_______________

Gift Certificate

Choose item or amount

_______________

Total

$__________

Print and complete form. Remember to include Check or Money Order. Thank you.

© 2003-2011 Madison Valley Veterans' Memorial. All rights reserved.
Last updated August 3, 2011
Webmaster

*Order Form* Eligibility: Veterans who have honorably served in peace or war, resident or nonresident, living or deceased. Battles, dates and/or units may also be commemorated. No orders accepted from May 31 - July 4. Bricks to be dedicated July 4, 2012 at the Memorial in Ennis, Montana. Newly dedicated bricks will be available to be reviewed on line, August 15, 2012. Make tax-deductible (Tax ID #68-0580264) Checks/Money Orders Payable: Madison Valley Veterans' Memorial P.O. Box 411 ~ Ennis, MT 59729
________________________ _______ __________________________ First Name MI Last Name Personal Awards (PH or higher), or KIA if killed in action ______________ _______ __________________ ________________________________ Rank Branch of Service Conflict (If Any), or Years served and/or _______________________________________________________ Battle/Date/Unit Categories (3 Lines, Max. 14 Chars. per line including spaces) Example: Click Here and Note Battle/Date/Unit Categories here in red. Donor's Name/Phone ___________________________________________ Place this brick with _______________________________
Quantity	Item/Description	Each	Total
_______________	Bench (Includes Miniature Cowboy, 8"x8" brick and 4"x8" brick)	$5,000.00	_______________
_______________	Story Plaque	$3,000.00	_______________
_______________	Miniature Cowboy	$1,200.00	_______________
___________	Brick 8"x8"	$1,000.00	___________
_______________	Brick 4"x8"	$100.00	_______________
_______________	Gift Certificate	Choose item or amount	_______________
		Total	$__________
	Print and complete form. Remember to include Check or Money Order. Thank you. © 2003-2011 Madison Valley Veterans' Memorial. All rights reserved. Last updated August 3, 2011 Webmaster