Military Court of Honor – Farmington Community Events Center

Order A Brick in Honor or Memory of a Veteran

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Choose Brick Size *

4 x 8 Brick with three lines of text with 20 characters (including spaces and punctuation) per line - $ 50.00
8 x 8 Brick with six lines of text with 20 characters (including spaces and punctuation) per line - $ 100.00

Total Amount

$ 0.00

Line One Text (20 characters total)

Line Two Text (20 characters total)

Line Three Text (20 characters total)

Line Four Text (8x8 brick only) (20 characters total)

Line Five Text (8x8 brick only) (20 characters total)

Line Six Text (8x8 brick only) (20 characters total)

Credit Card Payment *

Card

Name on Card