Military Banner Program - Borough of Lewistown

Applicant Name(Required)

First Last

Applicant Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Applicant Phone(Required)

Applicant Email

Military Honoree Information

Honoree Full Name(Required)

Prefix First Middle Last Suffix

Honoree Rank(Required)

Branch of Service:(Required)

AIR FORCE

ARMY

COAST GUARD

MARINE CORPS

NAVY

SPACE FORCE

Years Served(Required)

example 1972-1976

Special Info

(WIA, KIA, POW, ETC)

Medals:

(PURPLE HEART, SILVER STAR, ETC)

Proudly Honored By:

(if left blank– banner will say “ A Grateful Community)

Photo for Banner

Accepted file types: jpg, jpeg, png, Max. file size: 10 MB.

Verify you're human...(Required)

Name

This field is for validation purposes and should be left unchanged.

Note: After submission of this form, payment must be submitted to the Codes office located at Borough Hall, 2 East Third Street. The banner can not be ordered until payment is received.