Brick (Paver) Order Forms - (Include this form with your order)

                          HOLMES HIGH SCHOOL - “WALKWAY TO THE FUTURE”

Name of Person ordering the brick:

Mr./Mrs./Ms. _______________________________________________________________________

Maiden Name :: _____________________________________________Class _________________

Phone Number :: ___________-_____________-______________________

Email Address :: ____________________________________________________________________

Street Address :: ____________________________________________________________________

City : ______________________________________ State : ___________ Zip :: _________________

No. of Bricks __________     X  $30.00 each     =          Amount Enclosed $________________

Brick dimensions are 4” X 8” with three lines of engraved text. 

Each line can contain only 13 characters (this includes spaces and punctuation).
Enter message to be engraved in spaces below. 
(one letter, space or punctuation in each ____ )

Line #1: ____   ____   ____   ____   ____   ____   ____   ____   ____   ____   ____   ____   ____

Line #2: ____   ____   ____   ____   ____   ____   ____   ____   ____   ____   ____   ____   ____

Line #3: ____   ____   ____   ____   ____   ____   ____   ____   ____   ____   ____   ____   ____

Mail To:

Holmes High School Alumni Association
c/o Connie Kiskaden, Treasurer
1841 Stahl Road
Hebron, KY  41048