Brick (Paver) Order Forms

(Include this form with your order)

HOLMES HIGH SCHOOL - "WALKWAY TO THE FUTURE"

Name of Person ordering the brick:

Mr./Mrs./Ms. _____________________________________________

Maiden Name: ____________________________________________

Class: _________________

Phone Number: ___________-_____________-_________________

Email Address: __________________________________________________________________

 Street Address: ____________________________________________________________________

City: ______________________________________

State: ___________ Zip: _________________

No. of Bricks __________ X $30.00 each = Amount Enclosed

$________________ Brick dimensions are 4" X 8" with three lines of

 engraved text. Each line can contain only 13 characters (this

includes spaces and punctuation). Enter message to be engraved in

 spaces below. (one letter, space or punctuation in each ____ )

Line #1: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 

 Line #2: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ____ ___

Line #3: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ____ ____

Mail To: Holmes High School Alumni Association

c/o Holmes High School

25th and Madison Avenue

Covington, Ky 41014