MARYVILLE PARKS

BRICK PAVER ORDER FORM

 

DONOR’S NAME:________________________________________________________________

ADDRESS:______________________________________________________________________

                     ______________________________________________________________________

PHONE NUMBER:________________________________________________________________

 

TO BE PLACED IN:          Centennial Plaza________          Memorial Walk_______

4" x  8" BRICK: 13 characters and spaces per line; 3 lines......................................$50.00

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8" x 8" BRICK: 13 characters and spaces per line; 6 lines.......................................$100.00

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12" x 12" GRAY GRANITE STONE: 18 characters and spaces per line, 9 lines and/or logo

  (Logo subject to review by the engraver) (Available in Memorial Walk only).......$200.00

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MAKE CHECK PAYABLE TO:  Village 0f Maryville Parks
Print this application and return with check to the Village Administration Building