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The Serenity Garden Brick Order Form

Fill out the form below and click Buy Now to complete your brick purchase.

Brick Selection and Engraving
   
Choose Brick Size:  4" x 8" Brick $150.00
8" x 8" Brick $275.00
   
Each line of text can contain a maximum of 15 characters.
**Spaces and punctuation count as characters**
 
For 4" x 8" Bricks, add up to 3 lines of text
Line 1: 
   
Line 2: 
   
Line 3: 
   
For 8" x 8" Bricks, you may add Lines 4 and 5
Line 4: 
   
Line 5: 
   
 
Acknowledgements
(optional)
   
Acknowledge my gift for (name):
   
Acknowledgement Type:  In Honor Of
In Memory Of
   
Send Acknowledgement To: 
Name: 
Street Address: 
City/State/Zip: 
   
Acknowledgement Card to Read: 
   
   

Brick Purchases Processed Through PayPal

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