CITY: STATE: ZIP:

PHONE:

EMAIL:

Contact Information:

NAME:

ADDRESS:

Please select one:

$50 4" x 8" Brick

12" x 12" Brick $250

FORM

BRICK PAVER ORDER

Please fill out all the contact information in case we have any questions about your order form. Should we have any questions, an Education Foundation representative will contact you directly.

All forms are subject to review and anything deemed inappropriate will not be processed.

A separate form is required for each brick. For additional forms, copy this one or call the KASD Education Foundation at 610-683-7361 ext. 5105

Please PRINT your message below. Please use all CAPITAL LETTERS.

-3 lines, 15 characters per line, 1 logo

8" x 8" Brick $100-5 lines, 15 characters per line, 1 logo

-7 lines, 15 characters per line, 1 logo

Logo Choices: 1 2 3 4 5 6

A

B

C

D

Logo Selection: _______

Please make checks payable to: "Kutztown Area School District Education

Foundation"

Please mail order form along with payment to: KASD Education Foundation

ATTN: Brick Order251 Long Lane

Kutztown, PA 19530

Photo Source: Dennis Krumanocker, DK Photo

Deadline for all forms is July 1, 2018