PAVER ORDER FORM

Print this page and return the completed form to the address below.

Create a permanent tribute to your family
and loved ones who have played an important part
 in the development of the
community of Franklin, Kansas.

Makes a great gift for a special occasion. Have your family name forever remembered. Place a permanent memorial paver in the Franklin Community Park.
A walking path within the Franklin Community Park will encircle the granite pavers.  This will be a permanant remembrance of your loved one or family.  
 Choose from 3 sizes.

4 x 8 - $50.00 (maximum 3 lines)

8 x 8 - $75.00 (maximum 5 lines)

12 x 12 - $125.00 (maximum 7 lines)
(maximum 14 characters per line-includes spaces  

Donor's Name:_________________________________________________________________________                            Amount Enclosed: __________________


Donor's Address:  ______________________________________________________________________

Donor's Phone #: ___________________________________

Engraving Information (14 characters per line maximum)

Line 1:___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 2:___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 3:___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ ($50 - 4x8) 

Line 4:___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 5:___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ($75 - 8x8)

Line 6:___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 7:___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ($125 - 12x12)
Please make check payable to:  FCCI

*************************
Send to:  FCCI,  Attn: Park Committee
P. O. Box 43
Franklin, Ks. 66735

Call 620-347-8387 or 620-249-9333 for further infomation

Payment can also be made through Pay-Pal
Community Park
Gifts, Momentos, Lasting Tributes
E-mail memrylane@yahoo.com