SVM BRICK ORDER FORM
(For a printable version click the link above)

Name____________________________________________________________________________________
Address___________________________________________________________________________________
City/State/Zip_______________________________________________________________________________
Email____________________________________________________________________________________
Phone____________________________________________________________________________________

Brick Size (circle one)
4X8 Red Brick -$100 – 3 lines of text
4X8 Granite Brick -$200 –3 lines of text
8×8 Granite Paver -$500 –6 lines of text
8×16 Granite Paver -$750 –7 lines of text
16×16 Granite Paver -$1000 –12 lines of text

Historic/Geographic Landmark (for 8×8 and larger pavers only; locations sold on a first-come, first-serve basis.)
1st Choice____________________________________________________________________________________
2nd Choice____________________________________________________________________________________
3rd Choice____________________________________________________________________________________

Brick Text (14 characters per line including spaces)
Line 1__________________________________________________________________________________________
Line2 __________________________________________________________________________________________
Line 3__________________________________________________________________________________________
Line 4__________________________________________________________________________________________
Line 5__________________________________________________________________________________________
Line 6__________________________________________________________________________________________
Line 7__________________________________________________________________________________________
Line 8__________________________________________________________________________________________
Line 9__________________________________________________________________________________________
Line 10_________________________________________________________________________________________
Line 11_________________________________________________________________________________________
Line 12_________________________________________________________________________________________

Please mail your payment with this form to:
Swannanoa Valley Museum

223 West State Street (physical)
PO Box 306 (mailing)
Black Mountain, NC 28711
(828) 669-9566
info@swannanoavalleymuseum.org

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For Office Use
Date______ Paid_______ Method ____________