Brick Order Form

I would like to purchase _________ brick(s) fro the plaza at South Florence High School.

Name ________________________________________
Address ______________________________________
City/State/Zip ________________________________
daytime phone ________________________________
_______ check enclosed for brick(s)   
_______ cash is enclosed for brick(s)

Each engraved brick has room for 3 lines of copy with up to 14 letters per line counting spaces and punctuation. Please PRINT your name, year of graduation, etc. in the spaces.

Examples:

In Honor of
John Smith
Class of 2000		 In Memory of
John Doe
Class of 1985
John Doe
Football Captain
Class of 1998		 John Jacob
Stephenson

Brick #1 _____________________________
            _____________________________
            _____________________________

Brick #2 _____________________________
            _____________________________
            _____________________________

If the brick is in honor of in memory of someone else and YOU WOULD LIKE SOUTH FLORENCE TO NOTIFY THAT PERSON please give the name and address of the honoree below:
    Name _____________________________
    Address ___________________________________________________
    City/State/Zip _____________________________________________
 

**To order more than 2 bricks, please make another copy.

The South Florence Bruin Brick Committee reserves the right to refuse any name unsuitable and return payment to purchaser.