Historic Building Plaque Order Form This form can be used to order a Historic Building Plaque for buildings that meet the eligibility criteria listed on the Plaque Page. Payment can be made by PayPal after input of all information. Historic Building Plaque Order * indicates required field Name:* Email:* Re-enter Email:* Mailing address (street):* Mailing address (city, state, zip):* Preferred contact method:* email telephone Preferred phone number:* Please check the box to signal your agreement with the following statements: The Applicant will place the plaques outside and in an easily accessible public area, clearly visible from the public sidewalk/street right of way.* Location of the plaque must be approved by AAPS.* The Applicant and/or Building Owner will maintain the plaque.* By submitting this form and payment, I agree to the above conditions. Historic Building Address:* Construction or Built Date:* Eligibility Criteria S N Other If the Historic Building Study List designation is other than S or N, please explain how the building qualifies on the basis of other criteria. Eligibility Explanation: Please fill in as much of the below information as is documented. If no information is documented except for the year built, the plaque will simply read "Historic Building" at the top, with the year built and the address. Historic Name of Building Architect Builder: Listed as contributor to a historic district (select): Park Street Historic Commercial District NAS Alameda Historic District Listed as contributor to Heritage Area (select) Bay Station Burbank-Portola Leonardville Park Avenue Mounting option: Wood screws with rosettes Studs for masonry, stucco, stone Pole mounted (additional cost, AAPS will contact you to discuss) Please note: Plaques are available to AAPS members at a discounted rate. If you are not currently a member and want to be one, before completing this form, go to the "Join/Donate" page and fill out the online membership button and click on the PayPal "Add to Cart." Then come back to this form, order your plaque and certify you are a member, and use the PayPal button for members. AAPS Membership* I certify I am an AAPS member. I am not an AAPS member. Payment in full must be submitted for the application to be evaluated. If a property is evaluated, and found not to be eligible for a plaque, refund will be made less a small processing fee of $5. Payment:* I agree with the payment policy. Please submit form, and then submit payment using the PayPal button below. Leave this field empty Item choice Non-Member price $375.00 USD AAPS member price $325.00 USD
