Help Pave the Way
Order Form
Each brick paver ordered may include a maximum of three (3) lines of engraving. Each line may contain up to thirteen (13) characters (including spaces and punctuation). Please complete the lines below with the exact lettering you desire on your brick paver.

Corporations - $250    Individual/Family - $100
Schools - $50
Each brick paver ordered may include a maximum of three (3) lines of engraving.


Please PRINT clearly.

Line 1

  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  


Line 2

  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  


Line 3

  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  
Each brick paver ordered may include a maximum of three (3) lines of engraving.
Please PRINT clearly.
Name__________________________________________________________

Address________________________________________________________

City___________________________________________________________

State____________________________ Zip __________________________

email________________________________________________________
TOTAL AMOUNT ENCLOSED $___________________

Please print this order form with a check made payable to the
Town of Ramapo and mail to the address below.

The Lower Hudson Valley Challenger Center
225 Route 59
Airmont, NY 10901