The HERITAGE PARK FUND, INC.
invites you to buy a personalized brick, which will 
become a permanent part of the Heritage Park Walkway
in Heritage Park, across from the Floral Park Village Hall. 

Heritage Park Walkway Brick
 

ORDER FORM

  
Yes!

I would like to be a part of Floral Park's history by reserving the number of personalized bricks I have
indicated below.  I have filled out this form and clearly marked the message(s) that will be inscribed on my
brick(s).  You may use up to two (2) lines.  No more than fourteen (14) characters per line, including spaces.

I have enclosed $85.00 for each brick ordered.  I understand that I will receive a certificate to confirm
my inscription or name.
  

Name

 

___________
   Copy this
    form for
   additional
   purchases
___________
 

Mailing Address

 

City

 

 State

 

 Zip

 

Number of Bricks

 

@ $85.00
each =

 
  $
Mail order form with your check or money order payable to:   The Heritage Park Fund Inc.
  c/o Village Hall
  One Floral Boulevard
  Floral Park, NY 11001

* Heritage Park Fund Inc., reserves the right to decline any message that is deemed inappropriate. 
Telephone numbers, political messages, offensive or suggestive wording are restricted

Use up to 14 Characters ONLY per line,
including spaces.
(Telephone numbers are not permitted)

     Fill out your inscription below:     Please Print
Examples:
T h e    T H O M P S O N S   
A R R I V E D   1 9 7 3    

Brick #1
                           
                           
 LINE 1
 
LINE2
I N   M E M O R Y   O F     
D U S T Y   D O G          

Brick #2
Fill out if you are buying two bricks
                           
                           
LINE 1
 
LINE 2