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(To print, select File>print from your browser window)

Simply complete the enclosed form and send with your check made out to:  Clermont Renovations and mail to:

The City of Clermont
P.O. Box 6
Clermont, IA  52135

NOTE:  Although 16 spaces per line are shown on the above brick, our form only allows
13 spaces, this is to allow a greater border around the engraving to protect the lettering
from chipping.

  Cost of a brick is $100.00 with all proceeds going directly toward the downtown renovation project.  Simply complete the enclosed form and send with your check made out to:  Clermont Renovations and mail to: