House Plaque Application You can now order a new plaque for your historic home. Advance payment may be requested. The estimated cost is $75. House Plaque Information Name of Applicant(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) Phone(Required)Original Owner of Home(Required)Date or Circa of Home(Required)In the space provided print the name and date as you wish it to appear on your plaque. lf you wish to have "circa" included ln the date, include that in your sample. Also, use upper and lower case letter or all uipper case letters as per your choices on the form. Please be accurate, as we ate trying to do everything possible to avoid mistakes.Please select the shape of the plaque:Select:Rectangle, 9 x 12Rectangle, 6 x 9Oval, 9 x 12Oval, 6 x 9WritingFirst LineSecond LineThird LinePlaque Edging Bevel No Bevel Plaque Edging Round Not Round Histwick Angel?(Required) Yes No Letter StyleSelect:ROMAN, ALL UPPER CASERoman, Upper & Lower Casc<em>Italic</em>Background ColorSelect:White with black letteringHouse Color (you must prwide color chip)Dating(Required)Select:"Circa" & DateDate Only"C" & Date* Advance Payment may be requested. Estimated cost $75.
