Your Support Paves the Way!

Legacy Brick Order Form

Your Support Paves the Way! Honor a loved one, celebrate an achievement, or create a lasting tribute with an engraved brick in the heart of our campus library. Your personalized brick will become a permanent part of UP's story, inspiring future generations. Purchase an engraved brick and leave your mark on the future, today!
Name of Contact Person:

First NameLast Name
Organization Name (if applicable):
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
BRICK INFORMATION

Cost of Brick: $250.00

Brick Size: Three lines, 14 spaces per line (including blank spaces)

Example

Line 1: Linda Smith (11 total spaces)

Line 2: Class of 2020 (13 total spaces)

Line 3: Go Argos! (9 total spaces)

You are not requred to use all three lines.
Font Case (Please choose one):

ALL UPPERCASEAs Typed
Line 1 (14 spaces including blank spaces):
Line 2 (14 spaces including blank spaces):
Line 3 (14 spaces including blank spaces):
Signature: By signing below, I have proofread the above brick engraving form and attest that the above information is correct and is to be engraved as written above.

Powered by Jotform SignClear
PAYMENT OPTIONS

Option 1:

Please click HERE to make your payment online.

Option 2:

Make your check payable to: University of Providence Legacy Brick

Mail to:

Advancement Department

1301 20th Street South

Great Falls, MT 59405

Thank you for your support!

For questions, please visit Ross Remsen, Director of Alumni and Community Relations at ross.remsen@uprovidence.edu | 406.791.5926.
Should be Empty:

Legacy Brick Order Form

BRICK INFORMATION

PAYMENT OPTIONS

Option 1:

Option 2: