All Kids Playground - Brick Paver Order Form

All Kids Playground
Brick Paver Order Form

Name:

Address: City: State: Zip: Phone:

Brick Pavers:
12"x12" @ $1,000.00 each $
    8"x8" @ $250.00 each     $
    4"x8" @ $100.00 each     $
                                          Total: $

Visa/MasterCard:

Card No: Expires:

Signature:________________________________________

Make checks payable to NCJW/GDS

Mail this completed form to:

National Council of Jewish Women
Greater Detroit Section
26400 Lahser Road, Suite 306
Southfield, Michigan 48033-2675

PRINT EXACTLY as you would like the engraving to appear.
Use one character/letter per box, leaving a box blank for each space between words, etc.
Position and/or center exactly as you would like it to appear.

12"x12" Cornerstone
(7) Lines 21 Spaces

8"x8" Brick Paver
(5) Lines 14 Spaces

4"x8" Brick Paver
(3) Lines 14 Spaces