Include Your Name on the

Wind Point Lighthouse

Brick Walk

[  ] 8”x 8”     $100 (6 line up to 15 characters each)

[  ] 4”x 8”       $50 (3 lines, up to 15 characters each)

[  ] 12”x12”  $200 (10 lines, up to 20 characters each or artwork, crest, logo, etc.)

When purchasing multiple bricks, please submit a separate

From with engraving for each brick ordered.

Please engrave the brick as follows:

                       Engraving

Line 1. [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ]

Line 2. [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ]

Line 3. [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] limit 3 lines for 4”x 8” brick

Line 4. [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ]

Line 5. [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ]

Line 6. [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] [  ] limit 6 lines for 8”x 8” brick

For 12” x 12” brick, please print 10 lines of up to 20 characters each, or other artwork to be engraved on brick, on separate page, and enclose with order.  Purchaser is responsible for cost of any custom design artwork.

Purchaser Information                                             

Name:                                          

Address                                       

City/ St./ Zip                               

Phone #                                        

Mail completed form with your check or money order to:

Friends of the Wind Point Lighthouse

5110 Wind Point Road

Racine, WI 53402

Thanks for your order!