Brick Order Form

DIRECTIONS: Fill out your personal information. Below choose your brick size. Choose Graphic ($6.00 more) or No Graphic. If you chose to have a graphic check your graphic choice. Make sure to not exceed the number of characters per line allowed based on the size of brick that you order and IF it has a graphic as outlined below. *Note: Each space between words will also count as 1 character as does punctuation.

If you purchase an 4x8 brick and WANT NO GRAPHIC you have up to 3 lines of text (20 characters per line)

If you purchase an 4x8 brick and WANT A GRAPHIC you have up to 3 lines of text (15 characters per line)

If you purchase an 8x8 brick and WANT NO GRAPHIC you have up to 6 lines of text (20 characters per line)

If you purchase an 8x8 brick and WANT A GRAPHIC you have up to 5 lines of text (20 characters per line)

NOTE: If you want to use your own graphic (company logo, picture, etc) choose "My Own Graphic" option and email us your graphic at kelly.mwp@gmail.com. Put in subject line: BRICK GRAPHIC.
Full Name*
First and Last Name
Phone Number*
Area Code & Phone Number
E-mail*
email_addy@example.com
I want to order a*

4 x 8 brick NO Graphic ($55.00)4 x 8 brick WITH Graphic ($61.00)8 x 8 brick NO Graphic ($100.00)8 x 8 brick WITH Graphic ($106.00)
Brick text line 1*
Brick text line 2*
Brick text line 3
Line 4 (8x8 brick only)
Line 5 (8x8 brick only)
Line 5 (8x8 brick only)
Graphic on Brick (choose one option)*

NO GRAPHICMY OWN GRAPHICPOW/MIAAmerican FlagEagleStarAir ForceArmyCoast GuardMarinesNavyFire FighterLaw EnforcementAmerican LegionAMVETSVFW
Brick Placement*

Flag areaFire Pit areaMemorial areaWalk WayOther (will contact MWP)
Payment Method*

I will mail a checkI will deliver to MWP cashI will deliver to MWP a checkCall me to pay by Credit/Debit Card
I understand that unless a brick order of 5 or more (of the same size) is sent into the brick maker there is an additional fee of $29.50 per brick. Additionally, if there is a request to rush order the brick there is an additional fee $30.00. Please choose your brick order option below:*

I choose TO WAIT on other orders to be sent into MWP for NO additional costI choose to NOT wait on other orders and want my brick order sent in immediately ($29.50 extra fee)I choose to NOT wait on other orders AND I want it rushed ($59.50 extra fee)I am not sure, please contact me to discuss
Additional Notes:
If paying by check, make check out to: My Warrior's Place. Please make sure to write "Brick" in the FOR area on the check so we know that the check is to pay for a brick ordered.

You can mail payment for the brick to: My Warrior's Place 101 22nd Street NW #112, Ruskin, FL 33570 or you can request we call you to get payment information. A 5% credit card processing fee will be charged to cover the cost of processing your payment. If you have any questions or need any addtional information, please contact Kelly Kowall at (813) 321-0880 ext #1.
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