You may fill out this form online for the information on your plaque. However, it will not be ordered until we receive your payment which you can make with a check or online by clicking DONATE at the top of the page in the dark blue area. Be sure to select “Courtyard Bricks” from the dropdown menu and note that you must have an email address to use this payment method. Please note: You are limited to 18 characters per line on the plaque. If you have any problems getting this online form to submit, just copy this page and paste it in an email to [email protected].

 

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Donor Name
Your name
Field is required!
Field is required!
Address
street, city, zip
Your address
Field is required!
Field is required!
Phone number
Your phone number
Field is required!
Field is required!
Plaque placement
If you have a preference for the placement of your plaque, choose one.
Field is required!
Field is required!
Email
By providing your email address, you agree to receive design proofs electronically. If you elect not to provide an email address, you will be asked to proof the plaque at the church office.
Your Email Address
Field is required!
Field is required!
First line of text
use lower & upper case letters exactly as you wish the text to appear
line of text
only 18 characters allowed
only 18 characters allowed
Second line (optional)
use lower & upper case letters exactly as you wish the text to appear
second line of text
only 18 characters allowed
only 18 characters allowed
Third line (optional)
use lower & upper case letters exactly as you wish the text to appear
third line of text
only 18 characters allowed
only 18 characters allowed
Submit