Buy a Brick to be placed under
the Zimmerman grape arbor,
and help save one of Oregon's
most valuable historical treasures,
the Historical 1874 Zimmerman
House! Complete
and then print this form.
Mail it with your payment
to
our address as listed at the
bottom of this page.
THERE
ARE A LIMITED NUMBER
OF BRICKS. ORDER YOURS
TODAY!
BRICK INFORMATION
Date
Bricks @ $50.00 each
- 1 to 2 lines
Bricks @ $55.00 each
- 3 lines
Total Number of Bricks
Ordered. $
Total Amount Enclosed
INSCRIPTION
INFORMATION
Print
each name EXACTLY as
you want it to appear.
Leave a space between
first, middle, and last
names, and also before
and after an ampersand
(&). Spaces and
punctuation marks count
as characters. All letters
will be capitalized
and lines centered.
BRICK
1
Line
1
20 Characters Max
Line
2
20 Characters Max
Line
3
20 Characters Max
BRICK
2
Line
1
20 Characters Max
Line
2
20 Characters Max
Line
3
20 Characters Max
DONOR INFORMATION
Name
Address
City
State
Zip
-
Day
Phone
-
-
Night Phone
-
-
E-Mail
The FRW Historical Society
will acknowledge your
gift to the honoree
or to the family of
the person being remembered.
For an honor or memorial
brick please indicate
address where gift acknowledgment
should be sent:
