|
Bricks for Badges
Printable Brick Order Form
Please print and fill out
Name
___________________________________________ Date
_________________
Address
________________________________________________________________
Day Phone
________________________ Night Phone
__________________________
E-Mail
_________________________________________________________________
When personalizing your brick, please refer to these guidelines:
� There are 3 lines per brick, 20 characters per line.
� Each letter, space, punctuation mark or number counts
as a character.
� Letters may be in upper and lower case.
� Acceptable punctuation marks are: ~ ! @ # $ %
^ & * ( ) + = : ; " ' < > , . ? /
� All text will be automatically centered on each line -
you need not center it below.
� No inappropriate language will be accepted.
� Please print clearly.
Please personalize my brick as follows:
Donation
One 4" x 8" brick and one mini-brick (1�" x 3") = $ 150.00
Additional mini-bricks ($15 each) _______ x $15.00 =
$ ___________
TOTAL
= $ ___________
Please make check payable to COPS 8 and drop off/mail to: Bricks
for Badges
334
Royal Street
New Orleans, LA
70130
If paying online via Paypal, check here: _____
Form may be faxed to 504-523-2336.
|