Central Piedmont Brick Donation

* Indicates required field

Fill out the form below to order 1 brick for $125. Each 4x8-inch brick has space for 3 lines with 18 characters each. The text will engraved in all caps and will be centered on the brick. Carefully enter your desired text below. 

Brick Line 1 *
Brick Line 2
Brick Line 3

*Please review your text lines for accuracy. 

Choose Campus Location for Your Brick (Please note earliest placement dates.) *
Is this gift in honor, memory, or support of someone? *
  

Please enter your Contact Information

Is this gift on behalf of an organization? *
Yes    No
First Name *
Last Name *
Email *
Phone *
Mobile   Home   Work
Address *
Country *
City *
State/Province *
Zip/Postal *

Please enter your Billing Information

We accept the following cards
       
Name on Card *
Card Number *
Card Expiration Date *
/
Card Verification Value (CVV) *
?
Use same address as Contact Information
Billing Address *
Country *
City *
State/Province *
Zip/Postal *

*Please ensure that your text for the brick engraving is accurate. Once you hit the submit button, you cannot re-enter the information. 

Would you like to cover the transaction processing fee? *
 
Your Donation:
Processing Fee:
Total Payment:

  $125.00