INFORMATION TO BE ENGRAVED ON 4” X 8” PAVER
3 LINES OF UP TO 14 CHARACTERS PER LINE, PER PAVER,
SPACES AND PUNCTUATION
ARE CONSIDERED CHARACTERS, PLEASE PRINT CLEARLY.
PLEASE DO NOT ADD BOXES.
Please send the
completed form along with your check for
$50.00 payable to GRAUE MILL AND MUSEUM to:
Graue Mill and
3800 York Road
Oak Brook, IL 60523
If you choose
to charge the $50.00 to your credit card,
please complete the information below and fax the form to
Charge $ to my [ ] VISA [ ] Mastercard
Signature (Required for credit card purchases):