Brick Order Form
(One order form per brick please, please print, fill out and send
with your donation)
My name: ____________________________________________________________________
Address: ______________________________________________________________________
Phone: (_____)___________________
Email:________________________________________________________________________
О Fill in this circle if you would like to be contacted about
upcoming volunteer 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 check payable to: Hope for the Child
Mail this form and payment to:
Hope for the Child
8315 Emerald Lane
Woodbury, MN 55125
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: