Patio Bricks, 12 1/2" by 12 1/2" square

$250 each.  Please fill out one form for EACH brick you purchase.

Enter you desired text below, one 'letter or blank' per box (19 characters in each of 7 lines)

 

 

 

 

 

 

 

 

 

 

 

 

 

           

 

 

 

 

 

 

 

 

 

 

 

 

 

           

 

 

 

 

 

 

 

 

 

 

 

 

 

           
                                     
                                     
                                     
                                     

Your information:

Name_______________________________________________

Address_____________________________________________

Address_____________________________________________

City________________________________________________

State____________       Zip_____________________________

Phone: _____________________________________________

Email_______________________________________________

Signature____________________________________________

Include your check, made payable to:  Presque Isle Community Library.  Mail it to:  P.O. Box 115, Presque Isle, WI  54557.  THANK YOU!!!