9/11 SHS MEMORIAL
Brick Order Form
 
You can fill-out this form online, but you'll have to print it and mail it. 
You can not submit it online. 

Print this form and mail to:
Seaford High School
9/11Memorial Fund
PO Box 2425
Seaford, NY  11783

Questions ????

Call Seaford HS Guidance Department @ 516-592-4324

Make check payable in the amount of $75.00 to: 9/11 Memorial Fund
Or:
  I just want to help.  Please accept my donation of $____________

All contributions are tax deductible and will be used by the 9/11 SHS Memorial Fund
organization for tax exempt charitable purposes, pursuant to Section 501 ©(3) of the I.R.S. code.

Purchaser's Information:
Your name
Address
City, State Zip
Daytime Phone

  
Send a gift letter to:
Name
Address
City, State Zip


Bricks:  
Individual
 $75.00
Business/Corporation $150.00
  
Print (or type), one letter per box.
Spaces and punctuation marks count as one letter.
Maximum 12-14 letters per line.
EXAMPLE:   In Memory of
                         Steve and
                         Ann Smith