<p>Coloma Area Historical Society Shoppe Order Form</p><p>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)</p><p>16x16” with 12 lines of text (26 characters max. per line, please write inscription on back)</p><p>Write inscription here for 4x4 or 8x8:</p><p>Line 1: Line 2: Line 3:</p><p>Line 4: Line 5: Line 6:</p><p>Historical Coloma DVD $10</p><p>Packed with more than 150 photos of the Coloma area. Soundtrack written specially for the DVD by Coloma’s Clauson Family Music! </p><p>Shipping (if applicable) $1.50 $</p><p>TOTAL $</p><p>Please provide your mailing information (if applicable):</p><p>Name Street/Box City/State/ZIP Phone Email</p><p>Mail this form and your payment to: CAHS, Box 245, Coloma, WI 54930</p>