Brick Order Form

Coffey County Historical Society & Museum

Brick Order Form

Step Into The Past…

Step into Coffey County History!

Personalized bricks are only $40. All proceeds will fund the upkeep of the gazebo located at the Museum.

To order a brick by mail, print the form below, fill out the required information, enclose payment and mail to the address shown.

Name:________________________________________________

Address:_______________________________________________

City:______________________State:_________Zip:___________

***Please make check or money orders payable to:

Coffey County Historical Museum

Each brick may have 2 lines of print with 13 spaces each.

The Coffey County Historical Society & Museum

1101 Neosho Street

Burlington, KS 66839

620-364-2653

1-888-877-2653