MEMORIAL GARDEN 4x8" ORDER FORM
Contact Information:  Person Placing Brick Order           Control #                                                    
                                                                                          (For Administrative Use)
Name:                                                                            Telephone #                                              
 
Address:                                                                         E-MAIL                                                        
                                                                                                                   
State:                                 Zip Code:                         
Each brick can be engraved with one emblem and up to 3 lines of of text.  Please select Branch of service
for the Honoree or you can designate Legion, Auxiliary, or Sons of the American Legion Emblem. 
Each line can contain up to 20 characters (letters, punctuation, spaces). 
All Letters will be engraved in UPPER CASE. 

BRANCH OF SERVICE                                                   or                                                                    
                                                                                       (Designate AL, AUX, or SAL)                     

                                                                                 
Line 1 Line 2 Line 3

Comments/Instructions:                                                                                                                                                                                                                   
                                                                                                                                                                       
Cost per Brick                  $100.00        No. of Bricks Ordered:                           Subtotal:$                           
                                                                                                                                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.