Order Form

Block Paver [16" x 16"]

Ordering online requires filling out the form and submitting it.

Bricks can have ONLY 12 LINES with 30 CHARACTERS per line!

Contact Information Form

*Full Name:

Address Line 1:

Address Line 2:

City, State Zip:

*Phone:

*Email:

*Amount Paid:

Block Paver #1 engraved as written in this box.

A Maximum of
12 lines consisting of
30 characters each

(spaces are counted):

Block Paver #2 engraved as written in this box.

A Maximum of
12 lines consisting of
30 characters each

(spaces are counted)

12 lines of 30 characters each

Please send a charitable contribution receipt.