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Donation Form

Donation Amount:

$300.00$500.00$750.00$1,000.00

Paver information

What size paver are you ordering?*

12x12- $300

12x24- $500

24x24- $750

48x24- $1000

Please let us know where we can reach you to confirm what you would like your paver to say:*

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country:*

Mobile Phone:*

Email:*

Credit Card Information

Card Types Accepted:
Visa

Credit Card Number:*

Card Security Code:*

Expiration Date:*

Electronic Signature:*

I agree to pay above total amount according to card issuer agreement. Once the transaction has completed successfully, a confirmation receipt will be sent to the email address entered.

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