(please complete one separate form per brick ordered)
| Print and Mail to: | Deerfield Honors Veterans, Inc. |
| 7818 Woodside Court | |
| Maineville, OH 45039 |
$35 minimum donation = 4x8 BRICK WITH 3 LINES OF TEXT |
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$100 minimum donation = 8X8 BRICK WITH 3 LINES OF TEXT |
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$300 minimum donation = 8X8 BRICK WITH 2 LINES OF TEXT & LOGO |
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Logos require camera ready artwork |
Make checks payable to Deerfield Honors Veterans, Inc.
| Purchasers Name: | |
| Street Address: | |
| City, State, Zip | |
| Phone: | Email: |
3 Lines of Engraving
For Your 4" X 8" Brick: |
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_____ Check Here |
I would like an additional 4X8 replica brick shipped directly to the address above, as a personal tribute. I understand that it will not be included in the Deerfield Veterans Honor Park construction. Replica brick is an additional $47.50 and will be billed to your credit card. (Price include shipping & handling) |
visit us online at www.deerfieldhonorsveterans.org
Credit Card Information |
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| Name on Card: | |
| Card Number: | |
| Expiration Date: | |
| ___ Visa ___ MasterCard ___ Mail-in Check with printed order | |
Deerfield Honors Veterans, Inc. is an IRS approved 501(c)(3) public supported organization, and an Ohio recognized charity. Your contributions may be tax deductable. Please ask your tax advisor.
| By signing below, I verify that all provided information is correct. | |
| Signature __________________________________________________________ | |