Paving the Way Fund Raiser
Name_____________________________________
Address___________________________________
Phone_____________________________________
Amount of Donation __________________________
Previos Donation_____________________________
Donation amount and paver
$50-200 red paving brick
$200-1000 12X6X2 (inches) granite
$1000-4000 14X8X2 (inches) granite
$5000-up 20X10X2 (inches) granite
Printing on the paver
(max. of 3 lines with 16 spaces per line)
*letter placement may be determined by craftsman
Line 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Line 2 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Line 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Please enclose your order form and donation in an envelope and return to an address below. Please make check payable to the Hamilton Family Aquatic Center:
Paving the Way Paving the Way
c/o Security State Bank c/o John Wardwell
1111 Broadway 40 North 9th
Hamilton, IL 62341 Hamilton, IL 62341