Please fill out this form and, print it and mail it with your check or money order of $200 to our home office at this address:
Medina Wedding Chapel You may also use a credit card N853 Julius Drive with paypal.com Call or email for details. Appleton, WI 54914-9197
Please call us at (920) 707-6250 or e-mail us at medinachapel@gmail.com to confirm that the date you have requested is available before sending in your deposit.
Today’s Date: E-Mail Address: Names (Bride & Groom): Street Address: City, State, Zip: Home Phone: Cell Phone: Wedding Date: Day of the week:
Time of Ceremony: Rental Hours: We would like to reserve the chapel from to For example: You might have a 3:00 ceremony and rent the church from 2:00 to 4:30 We will locate a pastor/judge for your wedding. Which would you prefer?
Description
Total
Your Wedding Ceremony at the Medina Wedding Chapel
$625.00
Unity Candle ($20) 3 piece set ($25)
Aisle Runner ($20)
Window Candles 16 pcs ($30)
Subtotal
5% Wisconsin sales tax
Total
Subtract $200 non-refundable deposit to reserve date
-200.00
Balance due
Balance must be paid one week before ceremony Date due
Note: If this page is sent by mail, a confirmation letter will be sent back to you showing deposit paid, balance due, date due, wedding date and time, and any options you may have added. If it is returned in person, a copy will be made of this page at that time for your records.
