GHSF Brick Order Form

This Form can Accommodate up to 3 brick orders

Brick Dimensions are as follows: 4" x 8" x 2 1/4" or 8"x 8" x 2 1/4"

** NO REQUEST CAN BE GRANTED FOR SPECIFIC LOCATION PLACEMENT OF BRICKS.

Email address *

Name *

Your answer

Street Address *

Your answer

City *

Your answer

State *

Your answer

Zip *

Your answer

Telephone Number *

Your answer

Please Make Your Selection Below

One Brick (4" x 8" x 2 1/4") - $125

Two Bricks - $250

Three Bricks - $375

8" x 8" Brick Tile - $250 (Stock Logos are available for an additional $50. Custom Logos are available for an additional $75)

Brick Personalization

Each brick may contain up to 3 LINES WITH 13 CHARACTERS PER LINE.

Each punctuation and each space count as a character.

Each brick may contain up to 3 LINES WITH 13 CHARACTERS PER LINE. Each punctuation and each space count as a character.

Brick #1

Line 1 (13 Characters Only)

Your answer

Line 2 (13 Characters Only)

Your answer

Line 3 (13 Characters Only)

Your answer

Brick #2

Line 1 (13 Characters Only)

Your answer

Line 2 (13 Characters Only)

Your answer

Line 3 (13 Characters Only)

Your answer

Brick #3

Line 1 (13 Characters Only)

Your answer

Line 2 (13 Characters Only)

Your answer

Line 3 (13 Characters Only)

Your answer

Submit

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