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Click Here to Download and Print this form “WALK OF FAME” PAVER APPLICATION
I WOULD LIKE TO PURCHASE A (4 X 8) PAVER WITH TWO
LINES OF INSCRIPTION WITH 13 SPACES ON EACH LINE. PLEASE
ENGRAVE MY BRICK ON THE TWO LINES AS SHOWN BELOW.
($100.00)
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I WOULD LIKE TO PURCHASE A (8 X 8) PAVER WITH
FOUR LINES OF INSCRIPTION WITH 13 SPACES ON EACH LINE. PLEASE ENGRAVE MY BRICK ON THE FOUR LINES AS
SHOWN BELOW.
(Grey Granite - $200 Black Granite - $300)
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**Name of Purchaser if different than above**
_____________________________________
If you are interested in a
paver size 16 x 16 granite please call number below
for more information.
(Grey Granite - $600 Black Granite - $700)
Address:____________________________________________
Telephone:_________________________
Email address:______________________
Location of
Paver____________________
Make check payable to: D.O.I.T. and mail to POB 3303,
336.947.2177 janetharrold13@gmail.com
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