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Burford Skate Park Paver Stone Order Form

Engraved Paver Stones (8" x 8"): $1,000 Donation

For multiple paver stones, please use multiple forms.

* indicates a required field

IMPORTANT: To ensure that you move through all of the steps required to complete this online service, please use the blue buttons in this form and do not use the Back/Forward button in your internet browser.

Purpose

To make a donation by Debit Visa or credit card. If you have any questions regarding this form, please contact the Revenue Division.

Notice of Collection

Personal information contained on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c. 25 and will be used for the purposes of administering your request. Questions about this collection should be directed to the Supervisor of Information Services.

Make your donation on behalf of a Business

Yes

Engraved Message (Max 4 lines, 18 upper case letters including spaces and punctuation per line)

Minimum characters: 1