Prairie du Rocher Community Park
(8" x 8") Donor Brick Order Form 

1. Please print this form, complete & sign, and return with payment to PDR Bank.

2. Please fill in the name or phrase you wish to have on your donor brick.

3. Print exactly the way you wish to read your brick.  Lettering will be in UPPER case.  You may also use numbers for the inscription.  Spacing in between words is considered a character.  Punctuation does require a space.  All text will be centered.  The character font size on any line exceeding 15 characters will be slightly smaller.

   • If using 1-3 lines (1-15 characters each) on your brick, the cost is $100.00.  Any line that exceeds 15 characters, the cost is $102.00 per brick.

   • If using 4 lines (1-15 characters each) on your brick, the cost is $104.00.  Any line that exceeds 15 characters, the cost is $106.00 per brick.

   • If using 5 lines (1-15 characters each) on your brick, the cost is $108.00.  Any line that exceeds 15 characters, the cost is $110.00 per brick.

   • If using 6 lines (1-15 characters each) on your brick, the cost is $112.00.  Any line that exceeds 15 characters, the cost is $114.00 per brick.

1. Once you have signed this form, any changes may result in an additional fee.
2. Make checks payable to:  PDR Park Fund
3. Return the signed order form and payment to:  State Bank of Prairie du Rocher, 219 Market Street, Prairie du Rocher, IL  62277
4. For questions, contact State Bank of Prairie du Rocher at 618-284-3440.

        Date                    Name of Donor                                            Phone No. (for questions)

        ________            ____________________________                _______________________

Copyright © 2000-2008  State Bank of Prairie du Rocher