Have a question? Give us a call: (302) 856-7958

Donate a Brick Form

                    Join the $125 Brick Club

of the Georgetown Public Library

     Please complete a form for each brick ordered

First Line {14 Characters}

I     I     I     I     I     I     I     I     I     I     I     I     I     I     I

Second Line (14 Characters)

I    I    I    I    I    I    I    I     I    I    I    I    I    I    I

Third Line (14 Characters)

I     I     I     I     I     I     I     I     I     I     I     I     I     I     I

14 Characters per line including spaces. Please use the ampersand (&} in place of "and" whenever possible. Right reserved to lay out the brick so it can be blasted and easily read.


Signature                                                                         

 

Name   --------------

Addres--------------

 

Address  --------------


Make checks payable and mail to: Friends of the Georgetown Public Library

123 West Pine St., Georgetown, DE 19947 or they may be dropped off at the

Library


Phone  ---------------

Dates: Form received                                                    


Payment received                                                                                                Payment deposited                  


Payment type

-------

 

Cash/Check#


Form faxed

 

Payment to Salisbury

Brick received

                                             

<->

Check#

                                             

Brick laid

   

By Whom

 

Location of brick

                                            

   

3.11.15