Falls Creek Brick/Paver Order Form

Bricks are $100 each and pavers are $250 each

Contact Information
Name*
First Last
Church Name*
Please include City: "Seminole, First"
Address*
Street Address City State ZIP Code
Email*
Phone*
Which type of brick would you like to purchase?*
- Brick ($100)
- Paver ($250)
Bricks are 4x8" and can have up to three lines of text with 16 characters per line. Pavers are 12x12" and can have up to 9 lines with 20 characters per line.
Brick Inscription
Line 1
Line 2
Line 3
Paver Inscription
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Line 8
Line 9
Payment Information
Credit Card*
Card Details
Cardholder Name
Additional Donation Amount
Total
$0.00

Contact Information