CHS COMEMMORATIVE PAVER ORDER FORM
TO BE DISPLAYED ON THE DRAGONWALK AT CHS
PERSON ORDERING PAVER(S)
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Use this form to order paver (limit 14 characters per line)
Use this form to order additional paver (limit 14 characters per line)
Use this form to order additional paver (limit 14 characters per line)
ORDER CONFIRMATION
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Choose paver type/number
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Business Pavers
These pavers are intended for business supporters of CHS.
$
100.00
Quantity
1
2
3
4
5
6
7
8
9
10
Individual Pavers
These pavers are intended for individual/family/friend supporters of CHS
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: