Preservation Alliance of La Crosse - Medallions Order Form

 Ea.    Qty.       Total          Description

$19 x ____ = $______ Martindale House (2009)
$18 x ____ = $______ Holy Trinity Church (2008)
$18 x ____ = $______ The Holway House (2008)
$18 x ____ = $______ The Pump House (2007)
$10 x ____ = $______ The War Eagle (2004)
$10 x ____ = $______ The LaCrosse Players (2003)
$10 x ____ = $______ Pettibone Beach House (2002)
$10 x ____ = $______ The Ott House (2001)
$10 x ____ = $______ First Evangelical Lutheran (2000)
$15 x ____ = $______ #4000 Locomotive (1996)
$15 x ____ = $______ Pettibone Pavilion (1995)
$15 x ____ = $______ Mons Anderson House (1994)
$15 x ____ = $______ Christ Episcopal Church (1994)
$15 x ____ = $______ UWL Main Hall (1993)
$15 x ____ = $______ Old Post Office (1991)
($10 ornaments can be purchased at 3 for $25; $15 ornaments are 3 for $35;
Full sets of 22 ornaments can be purchased for $270)
_____________________________________
Total Order      $________         Shipping charges (within the U.S.):
Add Shipping  $________         1 or 2 items $2.00;  3 items $2.50;  4 items $3.00
Grand Total     $________         (5 or more, rush delivery, etc... call for quote)

 
Payment Method (check one):
_____ A check payable to PAL in the amount _________is enclosed
_____ Please charge my order to the following account:
 
Visa/MasterCard #: _____________________________Security code:______ Exp. Date: _________
 
Authorized Signature: ____________________________________________________

Please ship the order to me at this address:
 
_____________________________________________________________________
Name
 
_____________________________________________________________________
Address
 
_____________________________________________________________________
City, State, Zip
 
(________)_____________________
Phone
 
 
Send this page with your payment to:
 
        Preservation Alliance of La Crosse
        119 King Street
        La Crosse, WI  54601

 Ea.    Qty.       Total          Description

$19 x ____ = $______ Martindale House (2009)
$18 x ____ = $______ Holy Trinity Church (2008)
$18 x ____ = $______ The Holway House (2008)
$18 x ____ = $______ The Pump House (2007)
$10 x ____ = $______ The War Eagle (2004)
$10 x ____ = $______ The LaCrosse Players (2003)
$10 x ____ = $______ Pettibone Beach House (2002)
$10 x ____ = $______ The Ott House (2001)
$10 x ____ = $______ First Evangelical Lutheran (2000)
$15 x ____ = $______ #4000 Locomotive (1996)
$15 x ____ = $______ Pettibone Pavilion (1995)
$15 x ____ = $______ Mons Anderson House (1994)
$15 x ____ = $______ Christ Episcopal Church (1994)
$15 x ____ = $______ UWL Main Hall (1993)
$15 x ____ = $______ Old Post Office (1991)
($10 ornaments can be purchased at 3 for $25; $15 ornaments are 3 for $35;
Full sets of 22 ornaments can be purchased for $270)
_____________________________________
Total Order      $________         Shipping charges (within the U.S.):
Add Shipping  $________         1 or 2 items $2.00;  3 items $2.50;  4 items $3.00
Grand Total     $________         (5 or more, rush delivery, etc... call for quote)

 
Thank you for your order!