Historic House Plaque Program Order Form

Please select one of each by circling your choice:     *A portion is tax deductible!                    

         Plaque size:

         11x8 front mount      $265.00         Member price $239.00 +  Shipping cost $18.00

         11x8 sandwich mount   $325.00         Member price $293.00 +  Shipping cost $18.00  (for fence)

         11x8 w/18"stake        $300.00       Member price $270.00 +  Shipping cost $ 35.00 

         11x8 w/24" stake       $315.00       Member price $284.00 +  Shipping cost $35.00

         Angle or “lollipop” solder (your choice-stake only)

         Plaque color:

         Brown (most often chosen)                 Black

                                                                          Applicant Information

Name_________________________________________________________________

Address_______________________________________________________________  

Phone number____________________    Email address______________________________

Order date__________________     Payment enclosed (don’t forget shipping!)____________________

Plaque Information

Street Address ________________________________________________________

Original Owner’s Name(s)__________________________________________________

Date Built_____________________________________________________________

Architect/Builder (if Known)____________________________________________________

When all research is completed please return this form, check and research material to The Historical Society of Oak Park and River Forest, PO Box 771, Oak Park IL 60303-0771.  Research material consists of photos, original blueprints, original building permits, etc.  If you wish to pay with a credit card please contact the Historical Society at 708-848-6755.  Please allow 8-10 weeks for delivery; we will contact you when plaque is received.

Web site created by Marty Hackl m_hackl@ameritech.net