Veterans Memorial Garden

For a $135.00 donation, a personal message of your choice can be

engraved on a 4x8 paver.

All contributions are tax deductible to the full extent allowed by law.

Your contributions should be sent to:

Please print this page, fill out the following information, and mail the page to the address above.

NAME:____________________________________________________

ADDRESS:__________________________________________________

CITY/STATE/ZIP:_____________________________________________

PHONE:_________________E-MAIL:_____________________________

Please note: there is a MAXIMUM of THREE LINES with 16 characters of engraving per line.

You must count each punctuation mark(comma,hyphen,period,dash,apostrophe,space,etc) as a character.

WORDING CANNOT BE CHANGED ONCE IT IS SUBMITTED.

Enclosed is my payment of $135.00 for an engraved paver. My inscription of 3 lines or less is:

LINE #1: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

LINE #2: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

LINE #3: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

METHOD OF PAYMENT

CHECK: __ MONEY ORDER: __ CREDIT CARD: __

VISA AND MASTERCARD ACCEPTED

CREDIT CARD NUMBER: _________________EXP.DATE______CCV#_____

PAYPAL CONFIRMATION NUMBER: _______________________________

Jackson Township Veteran's Memorial Garden, INC. is a Non Profit 501(C) (3) corporation Tax ID# 32-0294677