Engraved Brick Paver Order Form

* Name

* Address

* City

* State

* Zip Code

* Email

* Home Phone

* Cell Phone

4" x 8" Paver $250

8" x 8" Paver $500

(Two) 4" x 8" $400

(Two) 8" x 8" $900

Brick #1:

* Brick Size

Please Select One4x8 (up to 3 lines)8x8 (up to 6 lines)

* Line 1 (max 18 characters)

* Line 2 (max 18 characters)

Line 3 (max 18 characters)

Line 4 (max 18 characters)

Line 5 (max 18 characters)

Line 6 (max 18 characters)

Brick #2:

Brick Size

4x8 (up to 3 lines)8x8 (up to 6 lines)

Line 1 (max 18 characters)

Line 2 (max 18 characters)

Line 3 (max 18 characters)

Line 4 (max 18 characters)

Line 5 (max 18 characters)

Line 6 (max 18 characters)

Please pay by credit card, check or e-check. If paying by paper check, please make checks payable to: "Temple Beth El Pavers" and mail to Temple Beth El, 16225 Winkler Road, Fort Myers, FL 33908.

Sat, January 18 2025 18 Tevet 5785

16225 Winkler Road, Fort Myers, Florida 33908
239-433-0018 www.templebethel.com

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