| Please reserve: |
Brick Paver(s) at $75.00 each and/or |
|
Signature Brick(s) at $100.00 each |
| I'd also like: |
Replica Brick(s) at $39.92 each (includes shipping and tax) |
My Paver(s) should be
inscribed as follows: |
Line 1: |
| |
The inscriptions are limited to 15 characters per line on two lines.
Please be sure to count blank spaces and punctuation marks as characters.
|
| I would like my Signature Brick(s) placed near to the following autograph: |
|
|
*Those ordering
replica brick, please add street address in addition to P.O. Box number or RD number. UPS
will not deliver without a street address. |
Fill in this form and fax it to (215)952-5724 or mail to:
The Walk at the Wachovia Center
3601 S. Broad St.
Philadelphia, PA 19148
|