Order Form


Eligibile for veterans who have honorably served in peace or war who are residents or nonresidents, living or deceased.
Battles, dates and/or units may also be commemorated.
Orders received after April 1st 2017 will not be dedicated until the following year.

Bricks to be dedicated July 4, 2017 at the Memorial in Ennis, Montana.
Newly dedicated bricks will be available to be reviewed on line, August 1st, 2017.

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

Madison Valley Veterans' Memorial
P.O. Box 411 ~ Ennis, MT 59729
jonemare52@gmail.com


________________________  _______   _________________________________________
              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 (Ex-1992-1994) 

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
_______________
Stone Bench
$5,000.00
_______________
_______________
Story Plaque
$3,000.00
_______________
_______________
Miniature Cowboy (Sold Out)
$1,200.00
_______________
___________
Brick 8"x8"
$500.00
___________
_______________
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 Juli 17, 2012
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