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 wit your payment.
Line 1 (16 letters or spaces per line)
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Line 9 (16 letters or spaces per line)
9 lines $250.00
Note:
For larger letters, skip a line.
Only one brick order per page.
Your Name:
Your Mailing Address:
City:
State:
Zip:
Your Area Code & Phone Number:
Amount Paid:
$ 250.00
Cash:
Check:
Money Order:
Cashier's Check:
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
