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Brick Paver Fundraiser Form McLaren Lapeer Foundation
McLaren Lapeer Region Foundation
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Brick Paver Fundraiser Form McLaren Lapeer Foundation
*Indicates required information
Please reserve my brick and engrave my inscription as follows:
Letters, spaces and punctuation count as characters!
Line 1 (Up to 16 characters per line including letters, numbers, spaces and punctuation.):
Line 2:
Line 3:
Line 4:
Line 5:
Purchaser Information
First and Last Name:
Address:
City:
State:
Zip Code:
Phone
Size of Brick:
11 3/4 x 11 3/2 paver is $100
17 5/8 x 17 5/8 paver is $200
11 3/4 x 23 1/2 paver is $200
23 1/2 x 35 3/8 paver is $250
Payment Method:
I will mail my check to McLaren Lapeer Region Foundation
Please bill me
Please contact me for my credit card information
Captcha*
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