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Oregon Fire Service Museum
Concrete Order Form
Your Donation is Tax Deductible
Donate $100 to the Oregon Fire Service Museum and help build our museum floor. You can purchase concrete
with this form, or online at http://www.oregonfireservicemuseum.org.
Get in on the
“Ground” Floor
$100.00 per
yard
In recognition of your donation of one cubic yard of concrete, you will receive a certificate of participation in
our Ground Floor Project. Everyone who participates in the Ground Floor Project will have their name
included in the contributors list that will be displayed in our new museum building.
Purchase Information
First Name:
Last Name:
Address:
City:
State:
Phone:
Email:
Please Bill Me
Signature:
Zip:
Check Enclosed
Mail completed form to:
Or Fax to:
Oregon Fire Service Museum
1284 Court St NE
Salem, OR 97301
(503)364-9919