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Memorial Order Donor Paver Form 8 x 8

Go to "print page" at the bottom of the page to print an order form. 
New Holstein Veterans



To remember and honor those who served in the military, we wish to build a memorial dedicated to their
sacrifice and to keep their memory alive for future generations.
Choose from the list below to dedicate a portion of the Veterans Memorial to a family member, loved
one, or friend who served our country.  The item chosen will be inscribed, as an example, with the
veteran's name, branch of service and years of service (Lines 1, 2, and 3). 

___ $250  Ring of Honor  12" x 12"               ___ $150  Donor Paver  8" x 8" 

___ $80  Donor  4" x 8"                                  ___ $____________  Other Donation

Please list your name and phone number for inscription confirmation:

name  ______________________________________________       phone __________________________
Checks payable to: New Holstein American Legion, PO Box 94, New Holstein, WI 53061

(All donations appreciated - THANK YOU)




8" x  8"  Donor Paver

Indicate inscription, limited to 6 lines with 14 characters or spaces per

 line.  Please print.


Line 1
Line 2
     Line 3     

Line 4


Line 5


Line 6