Order Online

Please select your item and fill out the boxes below with your inscription.

Please remember these simple guidelines:

• Items may be personalized up to 3 lines with up to
  20 characters per line.
• Please make sure your order form is accurate. Items are
  etched directly from the information submitted.

Please Choose From The Options Below

Donor Wall Plaque – Small $50.00 USDDonor Wall Plaque – Large $100.00 USDGranite Paving Stone $500.00 USDTable & Chair Set $1,500.00 USD

Line 1

Line 2

Line 3

You can also order your Wall Plaque, Paving Stone or Table & Chair Set by printing this form and sending your check or money order to:

HealthAlliance Guild
c/o Development Office
60 Hospital Road
Leominster, MA 01453