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SIDEWALK PAVER ORDER FORM
8X8" FOR POST ENTRANCE
Contact Information: Person Placing Brick Order
Control #
Name:
Telephone #
Address:
E-MAIL
State:
Zip Code:
Each brick can be engraved with one
emblem and up to 6 lines of of text. Each line can contain up to 20
characters (letters, punctuation, spaces).
All Letters will be engraved in UPPER
CASE.
Brick # 1 Emblem
AL
AUX
SAL
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Cost per Brick $200.00
No. of Bricks Ordered:
Subtotal:$
Total:$
Make Checks Payable to: Received by:
Hardin Post 113 Building Fund
Check #
You will receive a receipt by E-mail (If provided) or "Snail
Mail" with the inscription as you have entered.
PLEASE REVIEW AND SUBMIT CORRECTIONS IMMEDIATELY! CORRECTIONS CAN BE
SUBMITTED VIA E-MAIL AT
leroyhsmith@comcast.net or by
telephone 270-304-5060.
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