Brick Order Form
The information needed here is for the person paying for the brick. Anyone can purchase a brick honoring or encouraging veteran(s).
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Email *
Customer Name *
Customer Address *
Customer City, State, zip *
Customer Phone Number *
The information needed here is for the Veteran being honored.
The maximum number of characters allowed on each line is 16
Veteran's First & Last Name (16 characters max) *
Veteran's military branch of service *
Veteran's dates of military service (or) War *
Veteran's Home area (such as Lubbock, TX)
A copy of your responses will be emailed to the address you provided.
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This form was created inside of George S. Berry American Legion Post 575. Report Abuse