Walk of Honor Brick Order Form

	Home On-Line Store
	To Order a Brick:
1.	Fill out the form below.
2.	Print out the form and sign it.
3.	Make check payable to: Morgan County Veterans
4.	Mail check, order form to:	Morgan County Veterans Memorial
		Barb Carter 73 Laveianan Ct Martinsville, IN 46151-6755 (765) 349-1061

MEMORIAL BRICK
Please mark appropriate brick			Max.14 characters/spaces
POW	MIA	Line 1 of Brick
KIA	Purple Heart	Line 2 of Brick
Veteran	Home Front	Line 3 of Brick

MEMORIAL BRICK
Please mark appropriate brick			Max.14 characters/spaces
POW	MIA	Line 1 of Brick
KIA	Purple Heart	Line 2 of Brick
Veteran	Home Front	Line 3 of Brick

		Bricks @ $80.00 each (includes 1 certificate per brick)=

>	Form must be signed by the Purchaser.
>	Verify that all information is correct.
>	Your signature indicates acceptance of inscription on brick(s).
Please Note: Due to changing weather conditions, we cannot guarantee the original condition of the brick forever. We do guarantee the original brick will be without flaw. Incase of future damage or weathering, the brick can be replaced at cost by the customer.