Commemorative Plaques and Pavers Form

Commemorative Plaques and Pavers Form

Girl Scouts of San Jacinto Council
Honor a loved one, celebrate a special occasion, or show your commitment to empowering girls by ordering a commemorative plaque or paver. Your personalized tribute will create a permanent reminder of your support while helping to fund life-changing Girl Scout programs and experiences. If you have any questions, please feel free to reach out at to Suzanne Carmona at donate@sjgs.org or by calling 713-292-0334.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Location of Plaque or Paver
$2,000 - 16"x16" Paver, twelve lines, up to 24 characters per line plus Trefoil$1,000 - 8"x16" Paver. six lines, up to 24 characters per line plus Trefoil$500 - 8"x8" Paver, six lines, up to 14 characters per line$250 - 4"x8" Clay brick, three lines, up to 14 characters per line$100 - 4"x8" Clay brick,. two lines, up to 14 characters per line
$500 - 2" x 3.5" Brass plaque with three lines, 30 characters each$100 - 2" x 3.5" Brass plaque with two lines, 26 characters per line

Paver/Plaque Inscription

Write what you'd like your paver/brick/plaque to say here. Spaces and symbols are included as part of your character count.
Plaque/Paver Inscription
I would like to send notice of this gift to:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment Information
Check enclosed made payable to Girl Scouts of San Jacinto CouncilAmerican ExpressMasterCardDiscoverVisa
Name (as it appears on card)

First NameLast Name
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Card Number
Expiration Date
CVV Code
Zip Code
Signature
Date

MonthDayYear
Date
Should be Empty:

Paver/Plaque Inscription