Falls of the Ohio
Personalized Engraved Bricks

____________________________________
Name		    
____________________________________
Address 		   
____________________________________
City 		_______________
State 		_______________
Zip
____________________________________
Phone 		_______________
Date 		 

Print your brick message in the boxes below. Use one letter, punctuation mark, or number per box. A box must be empty between words. Price varies depending on message length.

$50 Brick
                           
                           

$55-$70 Brick

                           
       
$5
                           
       
$5
                           
$5
       
$5

Please make check payable to the The Falls of the Ohio Foundation, or you may charge as follows:

____ Visa ____ MasterCard

____________________________________
Card # 		_______________
Expiration Date		  

Mail this form with payment to:
The Falls of the Ohio Foundation, Inc.
201 W. Riverside Dr.
Clarksville, IN 47129