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Please PRINT this page, fill out and use one of our 3 convenient
ways to order: MAIL TO: Brick Campaign Fort Campbell Historical Foundation PO Box 2133 Fort Campbell, KY 42223 OR FAX: (931) 431-2620 OR PHONE: (Credit Card Orders Only) 9:00 AM to 4:30 PM CST (931) 431-2617 YES! I'd Like to order ___ Brick(s) at $36 each. TOTAL ORDER $_____ Please personalize my brick |__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__|__|__|__|__|__|__|__|__|__|__|__|__| Please personalize my brick |__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__|__|__|__|__|__|__|__|__|__|__|__|__| Please personalize my brick |__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__|__|__|__|__|__|__|__|__|__|__|__|__| Please personalize my brick |__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__|__|__|__|__|__|__|__|__|__|__|__|__| |__|__|__|__|__|__|__|__|__|__|__|__|__|__| ********************************************** If purchasing a Commemorative Brick/Historical Foundation Membership Package, please complete the following information. Service Member ____ Veteran ____ Civilian ____ Division: ___________ Regiment: ___________ Battalion: ___________ Company: ___________ Era Served ___________ Dates: ___________ ********************************************** NAME: ____________________________________________ ADDRESS: _________________________________________ CITY/STATE/ZIP: ____________________________________ PHONE: ___________________________________________ FAX: ______________________________________________ E-MAIL: ___________________________________________ PAYMENT METHOD (check one): [ ] Check Enclosed: Please make checks payable to The Fort Campbell Historical Foundation [ ] money order [ ] Credit Card: [ ]Visa [ ]Mastercard [ ]Amex [ ]Discover Credit Card Account# |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Expiration Date: MO |__|__| YR |__|__| Signature: __________________________________________ |