Gaston Museum
Paver Brick Fund Raiser Program
Order Form
Type your information, print this form and mail or
Print this form, fill in the boxes and mail with your payment.



Line 1 (16 letters per line - spaces count as one letter)

Line 2 (16 letters per line - spaces count as one letter)

Line 3 (16 letters per line - spaces count as one letter)

Note: 3 Lines Maximum - Omit one line for larger letters

Please, only one paver brick order per page.

Your Name:

Your Mailing Address:

City:


State:                           Zip:

Your Area Code & Phone Number:

Amount Paid:
$ 100.00
Please check the box to the right of your payment method.

Cash: Check: Money Order: Cashier's Check:

Your paver brick purchase is tax deductible.
Make payments payable to:

Gaston Museum

Mail this order form and your payment to:

Gaston Museum Brick Paver Program
Post Office Box 301
Joinerville, Texas 75658-0301



11-15-2001