1. PERSONALIZED
BRICK PAVER ORDER
FORM
PURCHASER'S NAME
STREET
CITY. STATF. ZIP
PHONE
INFORMATION TO B EENGRAGED
O N 4" X 8" P A V E R
U P T O 14 C H A R A C T E R S P E R L I N E , P E R P A V E R , S P A C E S A N D P U N C T U A T I O N
ARE CONSIDERED
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CHARACTERS. PLEASE PRINT CLEARLY.
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3 L I N E S 14 C H A R A C T E R S P E R L I N E .
PLEASE DO NOT A D D BOXES
NOTES:
I f y o u w a n t t w o ( 2 ) lines engraved o n y o u r brick the cost w i l l be $ 7 5 . 0 0
I f y o u w a n t three (3) lines engraved o n y o u r brick the cost w i l l be $85.00
M a k e checks payable to:
Haynes School A l u m n i Association, Inc.
M a i l checks to:
Stanley Marshall
132 Stillhouse R o a d
Hendersonville, T N 37075