Riverfront Project Donation Form

First Name Last Name
Address
Address State Zip Code
Day Phone (xxx) xxx-xxxx Night Phone (xxx) xxx-xxxx
E-mail address
Web site

Fill in the number of pavers you wish to purchase with your donation

 4 X 8 Engraved Paver with (3) three lines of print @ $100 ea.
 8 X 8 Engraved Paver with (6) six lines of print @ $200 ea.
  Clip art Choices           Add (1) Symbol/graphic to Paver (Clip art # )   
  Layout Examples      Layout 

Please list what you would like printed on your Paver(s).   [4 X 8 Paver three (3) lines]   [8 X 8 Paver six (6) lines]     
Limit lines to 20 characters per line including spaces and punctuation

Line 1 Line 2
Line 3 Line 4
Line 5 Line 6
Comments:

Other projects that I would be interested in donating to:
Southern Aroostook Partners for Trails

Vital Pathways General Fund

Please make checks payable to Vital Pathways Riverfront Project

PLEASE print this form after filling it in and mail it with your donation to:
Vital Pathways
P.O. Box 1437
Houlton, ME 04730
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