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2. Contact Information

   All fields below required

4. Applicant/Donor Name*
5. Address*
7. Email Address*
8. City*
10. Primary Phone Number*
11. State*
13. Alternate Phone Number*
14. Zip*
16. I Would Like to Donate the Following:
18. Hubbard

    Hubbard Park Bench - $2,500
19. $

    Contribute an Amount Toward a Hubbard Park Bench
21. Location of Bench

    Click here for map and enter selection of location for bench.

23. Atwater

    Atwater Park Bench - $4,000

24. $

    Contribute an Amount Toward an Atwater Park Bench

26. Location of Bench

    Click here for map and enter selection of location for bench.

28. Plaques for Benches

     

30. I would like a plaque furnished by the Village with the follow inscription:

    (may not exceed four lines of text, 24-26 characters per line)

32. 
    

    
    

    
    

34. Requested Park & Site Location Identified by the Village
38. Acknowledgement of Terms
    Click here for the form.
39. I Accept (click button)*

    1. Yes
    2. No

     

41. Applicant/Donor Name*
43. Would You Like to be Contacted Following Donation Completion?

    1. Yes
    2. No

47. Your application is considered complete when payment is made via our Invoice Cloud Payment Portal (select Bench from drop down menu), postal mail, gray mail box located in the east parking lot of Village Hall or provided in person in Village Hall, 3930 N Murray Avenue, Shorewood, WI 53211.

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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

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