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LowcoBricks Order Form
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* Indicates required question
What Brick
*
Bronze $25
Silver $50
Gold $100
Platinum $150
Number Of Bricks
*
Your answer
Text (1-3 lines)
*
Your answer
Address
*
Your answer
Wording and clip art (Only for Gold Level Buyers)
Your answer
Tile wording/Tile clip art (only for platinum buyers)
Your answer
Font
Your answer
Payment
*
PayPal
Cash
Check
Name (First and Last)
*
Your answer
DISCLAIMER
Any language or images that are deemed inappropriate by our team will not be completed. We will send you an email asking for a revised appropriate versing. Thank you, Have a great day
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