Herron Morton Place Historic Park

To support the fundraising efforts, the Herron Morton Foundation is selling commemorative bricks that enable you to contribute your own little piece of lasting history to the park. These bricks are available for $50 each. Every brick will be engraved with the text you choose, with up to three lines of 12 characters per line.

Get a brick for yourself, one for you other half and maybe even one for the family dog. For more information on how you can order one of these special bricks, please use the contact information provided below. If you'd like to order a brick, right-click and print the form below and fill out one form for each brick you would like to order and send it, with a check or money order for the full amount enclosed, to the address below.

(And don't forget - the portion of your order above $15 is tax deductible!)

Herron-Morton Place Neighborhood Park
Commemorative Brick Order Form

______________________________________________________________
Name of Orderer

______________________________________________________________
Contact Person, if a Business

______________________________________________________________
Mailing Address

______________________________________________________________
City, State, Zip Code

______________________________________________________________
Daytime Phone #, Evening Phone #

__________	$50 for the brick and up to 2 lines of copy
__________	$10 for a 3rd line of copy
__________	An additional, fully tax-deductible donation in support of the creation of the park.
__________	Total enclosed
	(Check payable to Herron-Morton Place Foundation, Inc.) The payment is due with your order.

Today's Date ____________________

Brick will be engraved exactly as you indicate below.

Print the lines for your brick very legibly (12 characters maximum per line including names, wording, spaces, and punctuation). Two lines of copy are available with your $50 payment. An additional 3rd line is available for an additional $10.

1st Line:

2nd Line:

3rd Line:

$15.00 of the portion of your order above is tax-deductible to the extent provided by current federal law.

Herron-Morton Place Foundation Federal ID# 35-1936232

No refunds for any reason. Re-orders due to orderer error will be at full price and payment will be due prior to engraving.

Send this form and check to:

Herron Morton Place Foundation, Inc.
PO Box 441722
Indianapolis, IN 46244