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Remember Madison Heights |

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MADISON HEIGHTS HIGH SCHOOL BRICK PAVER ORDER FORM
____8” x 4” @ $75.00 (two lines of text @ 18 characters per line including spaces and punctuation):
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____8” x 8” @ $150.00 (four lines of text @ 18 characters per line including spaces and punctuation):
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____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____
NAME _________________________________________________________________________________
ADDRESS ______________________________________________________________________________
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PHONE _______________________________
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