Brick/Paver Form

As the Capital Campaign continues, here is a special opportunity to show your support for our new building. Your donation of $250 or $500 entitles you to remember a loved one, honor a relative or friend, or promote your business.

Your brick will be laid in the path leading to the front entrance to the Library, to be seen by thousands of patrons and visitors for years to come.

For a donation of $250, each 4" x 8" brick can be etched with one, two, or three lines. A $500 donor can choose one 8" x 8" paver with up to six lines, or two 4" x 8" bricks.

We will unveil the brick and paver sidewalk in a special ceremony in early summer, 2016. Please fill in the form on the following pages and complete the payment information to order your brick or paver. Orders completed by March 15, 2016 will be included in the Summer 2016 installation.

* Required Fields

Brick/Paver Information
Amount
	Please enter your text below for your brick or paver. (Max 20 characters per line)
Paver Line 1
Paver Line 2
Paver Line 3
	Complete the following three lines for pavers only.
Paver Line 4
Paver Line 5
Paver Line 6

Contact Information
* First Name
* Last Name
Company Name
* Address
Address 2
* City
* State/Province
* Zip/Postal Code
Home Phone
Cell Phone
Work Phone
* Email

Help Us Cover Costs
Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.
Yes! I want $250.00 to go to Lancaster Community Library and I will donate $257.50. No. I will donate $250.00 and Lancaster Community Library will cover the processing costs.

Credit Card Information
Card Holder Name

Card Account Number
Expiration Date
* Security Code The 3 or 4 digit Security Code (CVV2) can be found on the back of your credit card. For American Express, the Security Code (CID) can be found on the front of the card.

Billing Address
Same As Above
* Address
City
State/Province
* Zip/Postal Code
Email

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