:: Donate








Please note: If purchasing an 8x8 brick w/logo please email your logo directly to mgalik@rappahannockunitedway.org in addition to completing the form below. Please send the highest resolution logo you can. If you have any questions, please contact Mickie Galik  at (540) 373-0041 ext. 308.



* 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 
Would you like to receive a Donor Certificate?
Would you like to receive a Donor Brick?
* Donation Amount $
Press the Continue button to enter the customized text that will be engraved on your bricks.

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