Remembrance Brick - Cost is $150.00 per brick (you may pay in full or up to 3 installments)

Payment plans (please choose the plan best for you)

__________ Plan A - Payment in full of $150.00

__________ Plan B - Two (2) installments of $75.00 (semi-annually)

__________ Plan C - Three (3) installments of $50.00 (semi-annually)

Name of Veteran___________________________________________________________________

Rank_____________________        Branch of service _____________________________________

Theatre of Operation______________________________ Theatre time of service ______________   

Time served in the military______________________

Please fill in the following information as the donor

Name____________________________________________________________________________

Address__________________________________________________________________________

City _______________________________    State _____________________  Zip ______________

Please return to:

Shawano Area Veterans Memorial

1136 Lincoln St.

Shawano, WI 54166

Attn: Tom Suttner