Brick Order Form

Buy a brick to help the Parish Life Center &Columbarium Memory Walk and memorialize yourself, a special date, your graduate, your family, a loved one, or an organization!

Samples of Messages:
Frank & Pat
D'Amato
2006
OR
In Memory of
Paul Cardea
1912-1993
One Order Form Per Brick
(No political or racial content will be allowed. The Officers of the PBOC Memory Walk reserve the right to refuse any message.)
1st Line

12 characters preferred including spaces
(up to 14 characters are accepted, but will shrink engraving)
2nd Line

12 characters preferred including spaces
(up to 14 characters are accepted, but will shrink engraving)
3rd Line

12 characters preferred including spaces
(up to 14 characters are accepted, but will shrink engraving)
Purchaser's Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Brick Location*
- PLC
- Columbarium

Samples of Messages:

One Order Form Per Brick

Purchaser's Information