PRINT-FRIENDLY FORM

Richmond Hill Veterans Monument

Name of Person Completing this Form: ____________________________________________________

Address: ________________________________________________________________________________

City: ________________________________ State: ___________ Zip Code: _____________________

Telephone: __________________________________ Email: ____________________________________

Each brick may have up to FOUR engraved lines; EACH LINE may contain ONLY 13 CHARACTERS including spaces. The following is only a suggested format. The brick will be based on only the information listed below, NO REFUNDS will be available.

Line 1: __ __ __ __ __ __ __ __ __ __ __ __ __

Name on Brick: (Example) JOHN B DOE

Line 2: __ __ __ __ __ __ __ __ __ __ __ __ __

Additional Name Line (For names that require more spacing) See Example 1

Alt use for Line 2: __ __ __ __ __ __ __ __ __ __ __ __ __

Rank and Branch of Service: (Example) SGT USA

Line 3: __ __ __ __ __ __ __ __ __ __ __ __ __

Years of Service: (Example) 1996-2003

Line 4: __ __ __ __ __ __ __ __ __ __ __ __ __

War Service: (Example) WWII & GULF WAR

Monument Brick ($50): _____ Method of Payment_________________________

Monument Sponsorship (Minimum of $500): _____ Method of Payment__________________

________________________________________________________________________________

Sponsors Name to be Engraved on Granite

Return to:

Richmond Hill City Hall
P.O. Box 250
Richmond Hill, Ga. 31324
Phone: (912) 756-3345 Fax: (912) 756-2031