Engraved Brick Order Form

Advent Parish Day School

Engraved Brick Order Form

Please print CLEARLY on the provided spaces, being certain to leave spaces between words and designating commas or other punctuation.  All names will be centered on the bricks during engraving.

Individual Brick:  4 inches x 8 inches - $100/each                          
Quantity Ordered: _____

Each line may include up to 14 characters of text, including punctuation and spaces.

Line 1   ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 2   ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 3   ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Family/Business Brick:  8 inches x 8 inches - $200/each                
Quantity Ordered: ______

Each line may include up to 14 characters of text, including punctuation and spaces.

Line 1   ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 2   ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 3   ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 4   ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 5   ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

Line 6   ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___  ___ 

By signing this form, I, _____________________________________ (please print name),
verify that I approve of the spelling, punctuation, and spacing as filled out by me on the lines above. 

______________________________________                    ______________________________

Signature                                                                                Witness Signature (office staff)

______________________________________                    ______________________________

Date                                                                                        Date

Checks should be made payable to Advent Parish Day School (marked Bricks) and should accompany this form. All orders are due by Friday, April 1, 2011.  Engraved bricks will be completed, delivered and installed within the two months following this deadline.  Please provide your contact information below so we can contact you with details about a brick installation party or if there are questions regarding this brick order and payment.  Thank you!

Email: ________________________________________    Phone: _________________________   

Mailing Address: _________________________________________________________________