Madison Valley Veterans' Memorial Order Form

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
Webmaster

*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 Webmaster