Brick Logo Order

Brick Logo

Please fill out the information below to process your brick. Please fill out the three message lines below with 12 characters max each. Spaces and punctuation count. You will be able to upload your logo file, too. After clicking submit, you will be taken to a webpage that will allow you to go to PayPal to pay the $200 donation for the brick.

Name*
First Last
Organization (if applicable)
Address*
Street Address City State ZIP Code
Email*
Enter Email Confirm Email
Phone*
Message Line #1*
Message Line #2
Enter a space if you want this blank
Message Line #3
Enter a space if you want this blank
Upload Logo File*