BUY A BRICK!

BUY A BRICK!

Space is limited, Only 300 spots as each brick is 4" x 8" size

Engraving on bricks will be in all capital letters.

Bricks will be placed on the East side of the 48’x81x16’ Warehouse.

ANY SYMBOL IS CONSIDERED ONE SPACE (PERIOD, COMMA)

ALL TEXT IS CENTERED UNLESS OTHERWISE NOTED

4x8 Brick

4x8 Brick

EXAMPLE

G

O

N

E

W

T

O

N

H

I

G

H

L

I

O

N

S

S

T

A

T

E

C

H

A

M

P

I

O

N

S

2

0

0

2

,

2

0

0

3

,

2

0

0

4

Please circle if you wish to have one of the following pictures on your brick for an additional $5.00 charge:Cat      Dog     Heart     Angel

PLEASE RETURN THIS FORM & YOUR CHECK PAYABLE TO:

Ten Lives Club

P.O. Box 253

North Boston NY 14110

Name:______________________________Phone:(________________)

Address:____________________________________________________

City:___________________________________State:_______________

Zip:___________

Email Address:___________________________________________

Amount Paid: ___________________

FORMS MUST BE RECEIVED BY NOVEMBER 1, 2015

TO ORDER ONLINE, PRINT THE ORDER FORM ABOVE 
& MAIL TO:

TEN LIVES CLUB
ATTN:  WAREHOUSE CAMPAIGN
P.O. BOX 253
NORTH BOSTON, NY  14110
 
SUBMIT YOUR PAYMENT BELOW VIA PAYPAL. 

Brick 4 x 8 size

1 Brick $500.00 USD 1 Brick w/ picture $505.00 USD

  
QUESTIONS? Please call Alli at 716-646-5577 ext. 101

OR

SUBMIT YOUR BRICK ORDER ONLINE 
USING THE FORM BELOW!

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