Coloma Area Historical Society Shoppe Order Form

Description Price Quantity Total Honor Brick 4x4 $100 $ 8x8 $200 4x8” with three lines of text 16x16 $500 8x8” with six lines of text (13 characters max. per line)

16x16” with 12 lines of text (26 characters max. per line, please write inscription on back)

Write inscription here for 4x4 or 8x8:

Line 1: Line 2: Line 3:

Line 4: Line 5: Line 6:

Historical Coloma DVD $10

Packed with more than 150 photos of the Coloma area. Soundtrack written specially for the DVD by Coloma’s Clauson Family Music!

Shipping (if applicable) $1.50 $

TOTAL $

Please provide your mailing information (if applicable):

Name Street/Box City/State/ZIP Phone Email

Mail this form and your payment to: CAHS, Box 245, Coloma, WI 54930