The bricks are 6 X 8. Up to 4 lines may be inscribed with 13 characters and spaces on each line. The donation is $100.

Line 1: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Line 2: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Line 3: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Line 4: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Your Name: _________________________________________

Street: _____________________________________________

City: _________________________ State: _________ Zip: _______

Phone # _________________________

Would you like us to send a notice to the recipient? YES,NO

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Recipient’s Name: ________________________________

Street: ________________________________________

City: _________________________ State: _________ Zip: __________

Phone # _________________________

Setting Date:  Unavailable at this time, we will notify you when we are ready to set.  Please send completed form with check made out to:     Mercer Veterans Memorial                                                     

          Marge Pemble

          4969N Hy 51

          Mercer, Wi 54547

    Questions call 715-476-3875 or  Email: mvmp@centurytel.net