Purchaser:

Name:_____________________________________________________

Address:__________________________________________________

City/State/Zip:___________________________________________

Brick Imprint Copy (please print)

_________________________________________________________

_________________________________________________________

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Maximum of 16 letters per line, including spaces, two lines for $40.00; three lines for $45.00. Make checks payable to Trego County Public Library Foundation.


Mail to:
Dave Harding
515 Russell Ave.
WaKeeney, KS 67672
(785) 743-5511