ALLENTOWN PUBLIC LIBRARY BRICK ORDER FORM NOTE A CHARACTER

Allentown District 5 Year Plan 20162021 Mission Statement
ALLENTOWN EAC 11810 MEETING DRAFT MINUTES PREPARED BY PETER
ALLENTOWN ENERGY EXPO SATURDAY OCTOBER 17 900 AM TO

ALLENTOWN PUBLIC LIBRARY BRICK ORDER FORM NOTE A CHARACTER
CITY OF ALLENTOWN SNOW EMERGENCY ROUTES STREET FROM TO
D D ALLENTOWN SCHOOL DISTRICT HEALTH SERVICES AUTHORIZATION

ALLENTOWN PUBLIC LIBRARY


ALLENTOWN PUBLIC LIBRARY

BRICK ORDER FORM

NOTE: A character means any character on a standard typewriter, including letter, number, punctuation mark and space. Maximum number of characters is 21 per line. The maximum number of lines is 4 lines. All text will be engraved in capital letters and centered!

Brick #1


































































































































Brick #2










































































































































































Brick #3










































































































































































TOTAL # OF BRICKS ______ @ $65 EACH = _____________


METHOD OF PAYMENT ENCLOSED:

(Note: All donations are appreciated; however checks or money orders are preferred)

CHECK _____

MONEY ORDER _____

CASH _____


PLEASE RETURN THIS ORDER FORM AND YOUR CHECK PAYABLE TO:

Allentown Public Library

PO Box 383

Allentown, NJ 08501


Name: ____________________ Phone: ___________________

Address: _________________________________________________

City: ___________________ State: __________________ Zip: _________________

Email Address: _____________________ Amount Paid: ________



-Order Forms with checks may also be handed in person at the library (not in the book return, please!)

-Donors will not be notified when the bricks are installed

-The library makes no guarantee as to where the brick will be installed on the sidewalk (cannot specify location or even preferred location)

-If you have questions, please call the Library at (609) 259-7565


Revised 4-2-15



O OF ALLENTOWN FFICE USE ONLY CLUB ID
SCHOOL DISTRICT OF THE CITY OF ALLENTOWN WILLIAM ALLEN


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