Newton Falls
Flower & Beautification Committee
Name: ________________________________________

Address: ________________________________________

________________________________________

Phone: ____________________

Total Due: _______________

Deposit Paid _______________

Amount Due on Delivery: _______________

Paid in Full: _______________

Date: _______________


Shepherds Hook Pole Brackets

Design Style Covered Bridge or City Seal (please circle one)

Small __________ $ 85.00 __________ $ 75.00
Medium ________ $ 95.00 __________ $ 100.00
Large __________ $120.00 __________ $ 195.00

Return orders to Kathy King, City Clerk, 19 North Canal Street.
Minimum 50% deposit required with order.