| Name: |
| Address: |
| City, State Zip: |
| Phone: | ( ) |
| eMail: |
| Mark where you want your logo or graphic and then print your message in the grid below: |
| Please enclose your camera ready art or logo, a simple sketch of your layout, the text you want on the tile and your check for $500.00 with this form to the address below. |
 |
Three Rivers Carousel Foundation PO Box 3655 Tri-Cities, WA 99302 |
We will call or email you to 'proof' the design before we engrave your tile.