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Engraved Brick Order Form
Special Request:
Family Grouping Name ___________________________
Person to be notified that a brick has been place in honor of them or a loved one.
Name _________________________________________
Address _______________________________________
City ____________________State _____ Zip _________
There are 3 lines on the bricks with 16 letters or spaces.
Please type or print legibly.
Line 1. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Line 2. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Line 3. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Person purchasing the brick:
Name ________________________ phone#___________
Address ________________________________________
City _____________________ State _____ Zip ________
Mail the brick orders with $45.00 to
Marcelene Wright, Treasurer,
750 Lancaster Hutchins
Lancaster, TX 75146
Only one brick per page.
Make checks out to "Friends of the Library".
Cost of each brick is $45.00