Carve Your Name in Stone!
Order a Unique Wilkeson Stone Paver Today!!
Help Renovate Kirkland’s Historic Church for Public Use!
Cost for Individual Paver - $50.00
5 3/4 Inches Square, 2 inches thick with 2 lines of 16 letters
A third line is available for an additional $10.00
PRINT THIS PAGE TO FILL OUT ORDER FORM
PLEASE COMPLETE ONE FORM PER PAVER
PRINT IN UPPERCASE, BLOCK LETTERS
Line 1
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Line 2
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Line 3 (Line 3 is optional for an additional $10.00)
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Purchased By: ___________________________________________________
Address: ________________________________________________________
City / State: ______________________________________ Zip: ___________
Phone: ___________________________ E-mail: _______________________
Amount Enclosed: _______________ Check # ______________
Please make check payable to: Kirkland Heritage Society: Pavers. Print Form and Mail to 1032 - 4th Street, Kirkland, WA 98033.
Questions? Please Call: 425 828-4095
The Kirkland Heritage Society qualifies for tax exemption under 501 (c) (3) and your donation is deductible to the extent allowed by law. We also qualify for match contributions by those employers who offer this benefit.
If your company matches contributions, Please provide Name of Firm: _____________________________________________;
and Contact: _________________________________________