brickorder

Please enter all requested information in the form below

Return it with check or money order for each brick made payable to

Macon County Historical Society
36 West Main Street
Franklin, NC 28734.
For more information, call 828-524-9758.

You may send one check for the total if ordering more than one brick.

but please use a separate form for each brick.

Name _____________________________________________________________

Address ___________________________________________________________

City __________________________ State _________________ Zip ___________

Telephone (___) __________________ E-mail ____________________________

Name(s) exactly as they are to appear on the brick. Maximum of 20 characters per line, including punctuation & spaces. Please print and use all CAPS, one character per space line (punctuation and spaces will consume one space line each.)

Line 1

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Line 2

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Line 3

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Total # bricks ordered	Price	Total enclosed
	$75.00

Please remember to enclose one page history of the honoree or event listed on the brick. This will be added to the record book available to researchers in the Historical Museum reference library

Thank you for your support of the Macon County Historical Society and Museum.