Hereford Inlet Lighthouse

Buy a Brick Campaign


   Date:________________________

Name

Address

City

State

Zip

Phone

Order Information

Amount per brick 4x8 $125  X ______ total $_______

Amount per brick 8x8 $225  X ______ total $_______

Add a symbol $9  X ______ total $_______

4x8 bricks may contain 3 lines with a maximum of 13 characters per line

8x8 bricks may contain 6 lines with a maximum of 13 characters per line

Note: Periods, commas and spaces count as a character

Brick #1 4x8

 

Brick #2 4x8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Brick #3 8x8

Brick #4 8x8

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please make checks Payable to : Hereford Lighthouse

 

Mail Check and Order Form to:

Hereford Lighthouse

111 North Central Avenue

North  Wildwood

 NJ 08620

Please return this form with your check before June 15, 2017 for the Oct/Nov 2017 installation .