Clinton, New York

Memorial/Commemorative Engraved Brick Paver Order Form

Please complete a separate form for each brick paver ordered.

Donation Type
Contact Info
Your telephone numbers:
Brick Paver

A 4x8 brick paver has space for 3 lines of text, 14 characters per line. (Characters include standard letters, numbers, punctuation, and spaces.)
An 8x8 brick paver has space for 5 lines of text, 14 characters per line. (Characters include standard letters, numbers, punctuation, and spaces.)
All engraved text will be in UPPER CASE LETTERS.
All engraved text will be centered.
Additional symbols and designs are available for an additional charge. Please contact us for further information and a quotation.

Donation Details

Is this donation of a brick paver in honor or in memory of someone else?

An acknowledgement of your donation will be mailed to you.

Would you like us to notify anyone else of your gift?

Donation / Cost Amounts
Payment Information
3- or 4-digit number on card. View Example
Expiration Date

If you need assistance or have questions, please call S. Sweetland at (315) 853-1489.

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