American Bungalow Registry Form and House Tile

Personalized House Plaque

CODE: Registry

Price: $235.00

Add Certificate and Window Placard: (+$9.95)

Registered Owner*:

Address*:

County:

City:

State:

Zip Code:

Map Book No. (If Known):

Architectural Style:

Year Built (Approx):

Name of Builder or Architect (If known):

No. of Stories:

No. of Bedrooms:

No. of Baths:

Approx. Square Footage:

Describe features of home: windows, additions, restorations, etc:

Describe the history of the house or other facts of interest::

Tile Inscription (3 Lines Max, 9 Letters Per Line incl. Spaces):

Quantity:

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This is the order form for the Plaque itself. No frame is included.

Personalized House Plaque