DOG PARK OF RARITY BAY
ONLINE MEMORIAL BRICK ORDER FORM

INSTRUCTIONS FOR USING THIS ON-LINE FORM:
Fill out the form using your computer, then print out the page with the form data (File, Print).
Mail to Cheryl Heinecke, 340 Marsh Hawk, Vonore, TN 37885 along with a check made out to
DOG PARK OF RARITY BAY, INC. Cost is $50 per brick.

Ordered by Telephone

E-mail Date of Order / /

Quantity of bricks ordered at $50/brick = $ Check #
A brick can say anything that you would like. It can be for people, animals, or other theme.
Each brick may have up to 3 lines with up to 14 characters of text per line.
Text includes all spacing and other signs ( & , - ,or ‘ )
It is not necessary to center the text used. An example:

T

H

O

M

A

S

C

D

A

V

I

S

V

I

E

T

N

A

M

V

E

T

1

9

4

4

-

2

0

0

4