Newton 311

Address

Newton City Hall
1000 Commonwealth Ave
Newton Centre, MA 02459
617-796-1000
TDD/TTY 617-796-1089

Hours

Monday - Friday
8:30am-5:00pm
Tuesday
8:30am- 8:00pm

Contact the WebTeam

 

Balsamo Millennium Park Brick Order Form

To order your brick(s) print out this form on your printer, fill it out and return it to:

Newton2000 Fund
PO Box 600429
Newton, MA  02460

Please make checks payable to Newton2000 Fund

For more information please call (617) 796-1500

Brick locations cannot be guaranteed. All donations are tax-deductible to the extent allowable by law. Newton2000 reserves the right to review all inscriptions.

Name:

Address:

City:

State:

Zip Code:

Day time phone number:

Evening phone number:

Number of bricks         x $100
Number of replicas   x $50
Shipping $11.95 per replica to New England and Florida
For other states call (617) 552-7130		    
Number of paving elements   x $500
  Total $

____ Check enclosed

Please charge my:

____ Visa (if possible, your Newton Card)

___ MasterCard

Number:

Expires:

Signature:

Three (3) lines are available per brick. You have a maximum 19 characters per line. You may use ampersands (&) commas and dashes. A space counts as one character. Spaces must be kept between names. M and W each count as two characters. Using ink, please print clearly. Dates should be expressed numerically (12/12/99). Additional order forms are available at Newton City Hall, Newton Free Library or the Newton2000 office.

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