Form Center

2. Adopt a Flossmoor Bench
   This is a wonderful way to commemorate someone special in your life or a memorable event! The cost of each plaque is $750. Proceeds will go to the Flossmoor public art fund.
4. First Name*
5. Last Name*
7. Address1
9. City*
10. State*
11. Zip*
13. Phone Number*
14. Email Address
16. Plaque Message

    Enter the exact message that will be engraved on the plaque in the space below. Each plaque accommodates 4 lines of 28 characters per line, including blank spaces.

18. Line 1
20. Line 2
22. Line 3
24. Line 4
26. Thank you for your support of the Flossmoor Public Art Program!

    Please remember that your online engraved plaque order will not be processed until your payment of $750 is received by the Village of Flossmoor. Payment can be dropped off in-person during Village Hall business hours or call 708-798-2300. You can also mail your payment to: Village of Flossmoor Adopt a Bench, Village Manager's Office, 2800 Flossmoor Road, Flossmoor, IL 60422. Please call 708-335-5424 with questions.

    ***Double check your spelling. The Village of Flossmoor will order the plaque exactly as specified and will not replace it if the error is not the Village's error.***

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field