Get Lilacia Park Memorial Brick Form

Lombard IL 60148 Donate an engraved memorial brick to be placed in the beautiful and historic Lilacia Park. Revenues from this program will be dedicated to improvements within Lilacia Park. Memorial Gift Brick Form www. Memorial Gift Park District Brick Lombard Do you want to recognize an organization you are grateful for thank an individual who gave a helping hand pay tribute to a life that has passed or celebrate a special date or occasion in your life Lombard Park District 227 W* Parkside Ave. Fill out the form in this brochure and send it to the Lombard Park District 227 W* Parkside Ave. Lombard IL 60148. lombardparks. com 630. 627. 1281 Please complete this form and return it to the Lombard Park District 227 W* Parkside Ave. Lombard IL 60148. Office hours are 8 30 a*m* 5 p*m* Monday Friday. For more information call 630 627-1281. PURCHASER INFORMATION office use only Name BRICK DETAILS 4 by 8 75 Print clearly Only one letter space or punctuation per box. Address City State Zip Email Daytime Phone 8 by 8 150 METHOD OF PAYMENT payable to Lombard Park District Check Visa Mastercard Check number Check amount Discover Expiration Date Security Code Name as it appears on card please print 12 by 12 300 Authorized Signature of card holder The Park District reserves the right to edit text and determine the location of the bricks. Due to the pattern of the bricks they can only be grouped in pairs. The exact installation date is not guaranteed* The purchaser will be notified when the brick is installed* A GIFT LETTER CAN BE SENT UPON INSTALLATION City State Zip Please sign the letter from OFFICE USE ONLY Date REQUEST received Received by please initial Date PAYMENT received Spelling punctuation and capitalization verified by Date brick ordered Ordered by please initial Date brick installed Date confirmation message sent Confirmation sent by please initial Logged. lombardparks. com 630. 627. 1281 Please complete this form and return it to the Lombard Park District 227 W* Parkside Ave. Lombard IL 60148. Office hours are 8 30 a*m* 5 p*m* Monday Friday. For more information call 630 627-1281. Lombard IL 60148. Office hours are 8 30 a*m* 5 p*m* Monday Friday. For more information call 630 627-1281. PURCHASER INFORMATION office use only Name BRICK DETAILS 4 by 8 75 Print clearly Only one letter space or punctuation per box. PURCHASER INFORMATION office use only Name BRICK DETAILS 4 by 8 75 Print clearly Only one letter space or punctuation per box. Address City State Zip Email Daytime Phone 8 by 8 150 METHOD OF PAYMENT payable to Lombard Park District Check Visa Mastercard Check number Check amount Discover Expiration Date Security Code Name as it appears on card please print 12 by 12 300 Authorized Signature of card holder The Park District reserves the right to edit text and determine the location of the bricks. Address City State Zip Email Daytime Phone 8 by 8 150 METHOD OF PAYMENT payable to Lombard Park District Check Visa Mastercard Check number Check amount Discover Expiration Date Security Code Name as it appears on card please print 12 by 12 300 Authorized Signature of card holder The Park District reserves the right to edit text and determine the location of the bricks. Due to the pattern of the bricks they can only be grouped in pairs. The exact installation date is not guaranteed* The purchaser will be notified when the brick is installed* A GIFT LETTER CAN BE SENT UPON INSTALLATION City State Zip Please sign the letter from OFFICE USE ONLY Date REQUEST received Received by please initial Date PAYMENT received Spelling punctuation and capitalization verified by Date brick ordered Ordered by please initial Date brick installed Date confirmation message sent Confirmation sent by please initial Logged.