- Brick Program

Permanent Brick - Order Form

Fundraiser for Jupiter Light Lodge
Cost: 4x8 brick $75.00, 8x8 brick $125.00 - 1 Logo: No Charge

The 4x8 Brick features 20 characters per row, three rows total without a logo, or 12 characters per row, three rows total with a logo of your choice on the right side. You may choose between the Square and Compass or Order of the Eastern Star (military and others available on request).

The 8x8 Brick features 20 characters per row, six rows total without a logo, or 20 characters per row, four rows total with a logo of your choice on the bottom.
Logo choice:*

Square & Compass Eastern Star No Logo Other (specify below)
If other logo, specify here (subject to availability):
Size (6% FL sales tax included):*
4x8 Brick $79.50 USD
8x8 Brick $132.50 USD
Your Information
Full Name*
First Name Last Name
E-mail*

Address*

Phone Number*
- Area Code Phone Number
NO LOGO 4x8 and 8x8

Please proofread CAREFULLY! - there will be NO REFUND for mistaken submissions
4x8 or 8x8 - line 1
4x8 or 8x8 - line 2
4x8 or 8x8 - line 3
NO LOGO 8x8 ONLY

Please proofread CAREFULLY! - there will be NO REFUND for mistaken submissions
8x8 only - line 4
8x8 only - line 5
8x8 only - line 6
WITH LOGO 4x8 and 8x8

Please proofread CAREFULLY! - there will be NO REFUND for mistaken submissions
4x8 or 8x8 - line 1
4x8 or 8x8 - line 2
4x8 or 8x8 - line 3
WITH LOGO 8x8 ONLY

Please proofread CAREFULLY! - there will be NO REFUND for mistaken submissions
8x8 only - line 4
8x8 only - line 5
8x8 only - line 6
Should be Empty:

Permanent Brick - Order Form