Yes, I would like to place a memorial brick on our Wall of Honor!
Name:________________________________________________________________
Address:______________________________________________________________
City:____________________________________ State:_______
Zip:________
in case of a question
day phone _______________ evening phone ______________
The brick has 3 lines. Each line has space for 20 characters,
be sure to include spaces and punctuation in the count.
- first line ___________________________________________
- second line ________________________________________
- third line __________________________________________
To purchase a brick, please print out form, fill in your information and inscription,
include your check for $150.00 and mail to:
Little Brothers Memorial Brick
527 Hancock Avenue
Hancock, MI 49930
|