Brick Order Form
Use your web browser’s Print function to print a copy of this form, then mail is to the address below for processing.
Leave a Library Literacy Legacy
Order Form
Purchaser’s Name_____________________________________________
Address___________________________________________
City, State, Zip_____________________________________
Phone__________________ Email_____________________
Make Check Payable to: Skidompha Library or Credit Card
(Circle One) Visa Master Card
Account #_________________________ Exp. Date_________ Signature__________________________________
Enter Engraving Details:
(1) 4 X 8 Brick: 1 line: 15 characters $50
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(1) 4 X 8 Brick : 2 lines 15 characters / line $100
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(1) 8 X 8 Centerstone: 3 lines 15 characters/line $300
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Space between words is considered a character
Special Symbols Available. Call Jeanne Davis, 207-563-5513
Mail to:
Skidompha Library P.O. Box 70, 184 Main Street Damariscotta, ME 04543
