Mailbox Replacement Program Order Form

Print and Mail. Fill out the Mailbox Replacement Form. Mail your payment to address below. We will call you when we receive your form.

Replacement Mailbox                 New Construction (no replacement)

Name: _____________________________________________________________________________
Address of Replacement: ____________________________________________________________
Day/Eve Phone: ___________________________________
Verify Street Number: ______________________________

Select Style & Color:

Hickory Mailbox
     Circle Box Color:    Black    White    Brown 
The Cedar Mailbox       
     Circle Box Color
:    Black      White      Taupe
The Hawthorn $350
The Ironwood $375
The Mighty Oak Mailbox                                            Or with Black Vandal box for $435
  Circle box color:     Black     White     Taupe      
The Beech
      Circle box color:      Black     White      Bronze    Circle accent color:   Copper      Nickel
The Birch Mailbox 
 Circle box color:      Black      White      Bronze    Circle Door Finish:      Brass Aluminum      Antique
The Linden
      Circle box color:      Black     White      French Bronze

                                                TOTAL DUE $__________________
                             Check or money order

Comments: ______________________________________________________________________________________________


Enclose check or money order to:
Palos Park Beautification Committee Mailbox Replacement Program
8999 W. 123rd Street Palos Park, IL. 60464