Brick Order Form

Order Form - Print and Mail to:

Santiam Heritage Foundation, Inc.

Post Office Box 161

Stayton, Oregon 97383

Make Checks payable to:

Santiam Heritage Foundation, Inc.

Donor Name _______________________________________________

Address ___________________________________________________

Phone # ( ) - _______ - _________

(You are limited to 3 lines with 17 character spaces per line - this includes blank spaces and punctuation)

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