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Gift Bricks® Pre-order Form

We're pleased you have considered fundraising with Gift Bricks. Note that all the following information must be supplied to Gift Bricks before a contract can be drawn and before any of our order can be processed. You also should understand that, unless a contract is drawn and signed, prices are liable to change without notice.

*Required Fields

Contract Information

Organization Name:*

Fundraiser Name:*

Authorized Signature Name:*

Contact Person Name:*

Contact Person Email:*

Contact Person Phone:*

Contact Person Fax:

Billing Address

Street Address 1:*

Street Address 2:

City:*

State/Province:*

ZIP/Postal Code:*

Shipping Address

(If necessary, you may change this address prior to order shipping.)

Same as Billing

Street Address 1:*

Street Address 2:

City:*

State/Province:*

ZIP/Postal Code:*

Brick Choice

Color:*

Brick Sizes:*

Typestyle:*

Layout:*

4x8 bricks have 1-3 lines, and 8x8 bricks can have up to 6 lines.

Engraving:*

Engraved Bricks for Humane Society

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