:: Donate


 

 

 

 


Donate

 

Memorial Brick Order Form

To purchase your brick, please fill out the order form below.

 

Please call me if you have questions.

Kristi Kent

Public Information

Rome-Floyd Parks and Recreation Authority

300 W. Third St. Rome GA 30165

706.291.0766 ext 14

 

* Your Name
Your Company
If you represent a company or organization, enter their name.
* Street Address
* City
* State/Province
* ZIP Code/Postal Code
* Phone Number
Fax Number
* E-Mail Address
* Brick Size
* Number of Bricks  (Amount of Same Size Bricks Ordering)
Would you like to receive a Donor Certificate? Add ($5.00)
Would you like to receive a Donor Brick? Add ($25.00)
* Donation Amount $
Press the Continue button to enter the customized text that will be engraved on your bricks.

Copyright � 2008 Bricks 'R Us
Read our Privacy Policy