Brick Order Form
(One order form per brick please)
My name: ____________________________________________________________________
Address: ______________________________________________________________________
Phone: (_____)___________________ Alternate Phone: (_____)_______________________
Email:________________________________________________________________________
О Fill in this circle if you would like to be contacted about our volunteering opportunities
1. Below pick your brick color and donation amount:
RED $100 (Supporter)
ORANGE $250 (Associate)
YELLOW $350 (Patron)
GREEN $500 (Partner)
BLUE $1000 (Elite)
PURPLE $5000 (Hero)
2. Please make your checks payable to:
Hope for the Child
1800 Arthur Street NE Amount enclosed: $ ______________
Suite #9
Minneapolis, MN 55418
3. In 24 characters or less, please clearly print the name, business or message you would like painted on your brick inside the box below: