Pathways to History Order Form

PLEASE PRINT THIS FORM, COMPLETE AND MAIL WITH YOUR CONTRIBUTION TO:

Cape May County Historical Society
504 Route 9 North
Cape May Court House, NJ 08210

Name____________________________

Affiliation______________________________________________________________

Address________________________________________________________________

Phone Number/ Fax_______________________

Amount Enclosed/ Charged: $______________

Please charge my contribution to my credit card: (circle one)

VISA MasterCard American Express 

Discover

Name on Card: __________________________________

Exp. Date: _______________

Credit Card Number _____________________________________________________

Inscription on brick:

4 x 8 brick: 3 lines of 13 characters each. ($100 contribution)

8 x 8 brick: 6 lines of 13 characters each ($200 contribution)

Please Print inscription:

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