Memorial Brick Order Form
Donor Name
*
First Name
Last Name
Donor Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Donor Email
*
example@example.com
Donor Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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{donorName} please read below before proceeding
.
The 8" x 4" brick is available for a donation of $80
and can be customized with text provided by the donor.
Donors can further personalize their brick by adding clip art from our selection.
Please note that including clip art reduces the space available for text
and adds a
$6.00
fee per brick.
If funds exceed the actual cost of the bricks, the remaining balance will be used
for parish improvements.
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Do you want clip art on this brick?
*
Yes
No
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Brick 1: Text only but with no Clip Art. Instructions: You can click on any cell you would like to start with. You can only have one character per cell. Please remember to leave a cell empty for any spaces.
Rows
Col. 1
Col. 2
Col. 3
Col. 4
Col. 5
Col. 6
Col. 7
Col. 8
Col. 9
Col. 10
Col. 11
Col. 12
Col. 13
Col. 14
Col. 15
Col. 16
Col. 17
Col. 18
Col. 19
Col. 20
Row 1
Row 2
Row 3
Brick 1: Text and Clip Art. Instructions: You can click on any cell you would like to start with. You can only have one character per cell. Please remember to leave a cell empty for any spaces.
Rows
Col. 6
Col. 7
Col. 8
Col. 9
Col. 10
Col. 11
Col. 12
Col. 13
Col. 14
Col. 15
Col. 16
Col. 17
Col. 18
Col. 19
Col. 20
Row 1
Row 2
Row 3
Brick 1: Clip art choices. One per brick. Click on the picture you want.
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Should be Empty: