Wisconsin and Ozaukee Humane Societies: Survey - Personalized Paving Brick Order Form

Personalized Paving Brick Order Form

Another great way to remember or honor a loved
one! A limited series of outdoor paving bricks
line the sidewalk to the Wisconsin Humane Society
building. For a $250 donation, your inscription
on a 4"x8" brick can include 3 lines, with up to
14 characters per line including spaces. For a
$500 donation, your inscription on an 8"x8" brick
will include 6 lines, with up to 14 characters
per line including spaces.

Please fill out your contact information.

*

Name:

First Required	Middle Required	Last Required

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

Country:

*

Phone Number: Required

Remember me. What's this?

Question - Not Required - What type of brick would you like to sponsor

Here is an example of how we will format your brick inscription based off your brick choice and size.

$250- 4"x8" (3 lines, 14 characters per line including spaces)

Example: _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _

$500- 8"x8" (6 lines, 14 characters per line including spaces)

Example: _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _

Question - Not Required - What would you like your brick to say based on your brick size?