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Memorial
Garden Paving Stone
Order Form
Print this page.
Please
complete all information and mail this form with payment in full to
(checks should be payable to Our Lady of the Chesapeake):
Our Lady of the Chesapeake
8325 Ventnor Road
Pasadena,
MD 21122
Please complete a separate order
form for each paving stone that you are sponsoring. Please be aware
that it may take up to several months for the stone to actually be
placed in the Memorial Garden.
Name:
_________________________________________
Date:
________________
Street Address:
______________________________________________________________
City,
State, Zip: _________________________________________________________
Telephone:
________________________________
Amount
Enclosed ($50 per paving stone) $___________________
Inscription
-- Please Print (14 characters each line, including spaces and
punctuation)
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___This
is a Gift. Please send an acknowledgement certificate to:
Name:
_______________________________________________________________
Address:
______________________________________________________________
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