Lawton Chiles Middle Academy - Brick Order Form

Fill out the form.
Print the form and send it in with your check.

Purchaser's Name

Address

City

State

Zip

Work/Cell Phone

Home Phone

Email address

Mail Certificate to Address Above

Check here to have mailed to the above address

Brick Prices:	1	brick	$40
	2	bricks	$75	(37.50 ea.)
	3	bricks	$110	(36.67 ea.)
	4	bricks	$145	(36.25 ea.)
	5	bricks	$180	(36.00 ea.)

Please make check payable to:
Lawton Chiles Middle Academy Brick Fund

Mail Order to:
Lawton Chiles Middle Academy
Attn: Brick Committee
400 North Florida Avenue
Lakeland, Florida 33801

Phone: 499-2742/Fax: 499-2774

The Deadline for all brick orders is
May 15, 2008.

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