Brick #1:

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Would you like to order more than one of this brick? If so, how many? __________

Third line is an additional $5.00!!!

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Brick #2:

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Would you like to order more than one of this brick? If so, how many? __________

Third line is an additional $5.00!!!

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Brick #3:

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Would you like to order more than one of this brick? If so, how many? __________

Third line is an additional $5.00!!!

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Your Name: ______________________________

Address: ______________________________

Phone Number: ______________________________

Total number of Bricks _______ at $25.00 each is $ ______________

Total extra lines _______ at $5.00 per line is ______________

Make check or money order payable to:
Auburn Parks and Rec/Community Playground

and send to:
Richard Byerly
812 Heard Ave.
Auburn, AL 36830