Form Center

2. Veterans Memorial Brick Paver Order Form
   For questions, contact Rebecca at 636-361-6326 x402 or email at rpate@manchestermo.gov
4. Ordered By
5. Phone Number
7. Email Address
8. Company/Organization (if applicable)
10. Address
12. City
13. State
14. Zip Code
16. Options*

    1. Brick Paver 4 x 8 inches 3 lines of text $110
    2. Large Brick Paver 8 x 8 inches 6 lines of text175
    3. Keepsake Replica Mini Paver 2.75 x 1.25 inches $11
    4. Granite Pilaster $5,000
    5. Granite Bench $2,500
    6. Armed Services Plaque- Army $1,800
    7. Armed Services Plaque- Navy $1,800
    8. Armed Services Plaque- Marines $1,800
    9. Armed Services Plaque- Air Force $1,800
    10. Armed Services Plaque- Coast Guard $1,800
    11. Armed Services Plaque- Merchant Marines $1,800
    12. RUSH SHIPPING $20

    Orders will be place only when we receive 5 or more orders unless you choose RUSH SHIPPING in addition to the paver
18. Inscription
    Enter exactly the way you wish your paver to read. There are 20 characters per line. Your inscription may also include numbers. Spacing between words and numbers and all punctuation is considered a character and requires a space. All lines will be centered on the paver. You will receive a proof to approve before the order is sent out for production.
20. LINE 1
22. LINE 2
24. LINE 3
26. LINE 4 (if applicable)
28. LINE 5 (if applicable)
30. LINE 6 (if applicable)
Leave This Blank:


32. Submit Submit and Print

* indicates a required field