Community Center Brick Ordering Form

BRICK ORDERING FORM Meadow Vista Community Center

1. Bricks are $50.00 (Fifty Dollars) each.

2. The number of text line can be from 1 to 3. Text lines are limited to 15 characters or spaces per line.
Examples:

Smith Family
John, Susan
Peter

Meadow Vista
Toy Store

Julia & John

Jordan

3. $16.00 of your donation will pay for the brick, the engraving by LASER IMPRESSIONS, Sunnyvale, Ca. and shipping.

4. $50 payment for each brick is due with order. Make checks or money order payable to MVCC Brick Sales. Mail this order form and payment (no cash) to:

MVCC Brick Sales
c/o Celia Lyman Broadwell
2720 Volley Lane
Meadow Vista, Ca. 95722

5. Write the text you want in the outlines below. Remember, the text lines are limited to 15 characters or spaces per line.

Purchaser: ________________________________________________________________
Street/PO Box: _____________________________________________________________
City: ______________________________ State: _________ Zip: _____________________
Total Bricks: _______ Amount Enclosed: ___________________

Thank You for Supporting the Meadow Vista Community Center.

Please print your message on the brick spaces below. Please print clearly.
If you are ordering more than three bricks, please print out a separate form and attach it to this one when mailed.

Brick #1	Brick #2	Brick #3
Smith Family John, Susan Peter	Meadow Vista Toy Store	Julia & John Jordan