Delaware State Police Museum
Brick Order Form

To order your Delaware State Police Museum Brick, just print and complete this order form
and send it in with your check made payable to "Delaware State Police Museum. Inc." to:

Delaware State Police Museum, Inc.
(An Educational Center)
P.O. Box 430
Dover, DE  19903-0430

Name: _____________________________________________________________________

Address: ____________________________________________________________________

City:____________________________________ State: _________ ZIP: __________________

Daytime Phone Number: (__________)_____________________________________________

Email Address: _____________________________ Total Amount Enclosed: $______________

Complete this Box when ordering a 4" X 8" Brick
Each brick may contain up to 3 lines of copy
18 Characters/Spaces per line.

Each box represents a Letter, Number, Punctuation or Space
You do not have to use all lines shown.

Bricks only $100.00 each