Buy a Brick Form

Buy A Brick

Leave Your Legacy with a Personalized Brick. Support ROAR Florida’s mission by leaving a lasting mark on our pathways! We’re raising funds to sustain our ongoing operations and resident programs and enriching the lives of our residents in the place they call home. By purchasing a personalized brick, you’ll contribute to a great cause and become part of ROAR Florida’s legacy: 4x8 Brick: $100 8x8 Brick: $250. Your custom brick will be placed along our pathways, showcasing your support for years to come. Don’t miss this opportunity to make a meaningful impact! Order Your Brick Today!
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please send an acknowledgement of donation to: (Please provide their name, address and phone number in the next field)
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Payment Method - Checks made payable to ROAR FLORIDA 500 Inspiration Dr. Lakelad, FL. 33805*

CardCheck
Please engrave our brick as follows:

Any symbol is considered one space (period, comma, dash) All text is centered unless other wise noted
$100 - 4x8 Brick:
Line one: blanks Line two: blank
Line Three: blanks Line Four: blank
$250 - 8x8 Brick:
Line One: blanks Line Two: blank
Line Three: blanks Line Four: blank
Line Five: blanks Line Six: blank
Acknowledgment*

I understand that the text I provide will be engraved exactly as written above, and any errors or omissions are my responsibility.
Choose your size:
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4x8 Brick$100.00

8x8 Brick$250.00

Total $0.00
Should be Empty:

Buy A Brick

Please engrave our brick as follows: