___ Quilt Pattern Approved

___ Quilt Location Approved

___To be painted by Volunteers

___ To be painted by Applicant

Payment Received

Barn Quilts of Lafayette County

Information Form for Barn Quilt Project

Date of Request______

Individual/Group requesting Barn Quilt______

Address of proposed site______

Contact Person: ______

Home Telephone: ______Work Telephone: ______

Cell: ______E-Mail:______

Mailing Address: ______

City______Zip______

___I/we plan to engage the assistance of friends or family members to paint the quilt square with guidance provided by the BQLC Committee as needed.

___I/we prefer to contact and work with the following community group which will paint the quilt square. ______

___I/we would like our barn quilt, name, address, and pictures to be included in BQLC brochures/website/map guides as deemed appropriate by the BQLC committee.

If you have a quilt pattern in mind, please include the name and a copy of the pattern. All blocks used will need to be approved by the BQLC Committee in order to maintain continuity, refrain from excess duplication and insure quality of the project. If looking for ideas for your barn quilt, go to barns.com/otherbarns/quilt/quiltbarns.html, a great resource for ideas when choosing your pattern.

Quilt pattern requested: ______

Colors to be used: ______

Please refer to page 3 for pricing.

(Please turn to page 2)

In making this application for a Barn Quilt, the undersigned agrees to accept the following conditions and requirements. Please initial each line below to indicate your agreement:

___I/we will work with the BQLC Committee regarding design and colors (red, yellow, orange, green, blue, black, white and purple) of the proposed barn quilt square.

___The quilt square will remain on the building at least five (5) years. After that time, the quilt square will remain on the building until the owner asks for it to be removed or it becomes apparent that the piece needs to be repaired or renewed.

___Barn or building site must be visible from the road or on a site that is frequently visited. The Committee will have the final say as to the appropriateness of the site.

___The barn quilt square is the property of the barn owner with BQLC committee having certain rights, i.e. postcards, calendars, repainting, removal.

___I/we agree to include my quilt block in any quilt trail developed and will follow the guidelines of the local committee.

Signature of requestor: ______

Printed signature: ______

Please return this form to: Barn Quilts of Lafayette County

c/o Phyllis Sonsalla

964 E. Lucy Street

Darlington, WI 53530

For more information on this project,contact the UW-Extension office at(608) 776-4820 or

.

“The University of Wisconsin Extension provides affirmative action and equal opportunity in education, programming and employment for all qualified persons regardless of race, color, gender/sex, creed, disability, religion, national origin, ancestry, age, sexual orientation, pregnancy, marital or parental, arrest or conviction record or veteran status.”

Additional Information Requested:

This information is not required for the original application, but would be helpful in developing future brochures and web-site information for self-guided tours. Please use a separate page to talk about

YourFarm: How long has it been in the family? Who bought it? When?

YourBarn: (For help with the history? Contact Marion Howard at the Lafayette Co. Historical Society (608-776-8340) When was it built?What was its original function? What is it used for now?What materials is it constructed with?Was the architecture determined by the function of the barn? Do you know the ethnicity of the builder?

Miscellaneous History:Do you have any interesting stories about the barn, the farm, the area, your family?

Quilt Block: Is there a reason why you chose this particular quilt block design?

Barn Quilt Pricing June 2010

Cost to
Barn Owner / Total Cost with mounting
2x2 / $ 50.00
4x4 / $ 75.00
6x6 / $ 175.00 / $250.00
8x8 / $ 185.00 / $250.00

Barn Quilt Instructions$ 10.00

Brochure Advertising* $ 20.00

*One time cost for participants who have made and mounted their own barn quilt but would like to be included in the BQLC project and brochure.

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Revised 6/8/10