Commemorative Brick Order Form

2. 

4. Commemorative Brick Order Form- The Park at City Center
   Commemorative Bricks are ordered twice per year, in May and in November. The cost per brick is $25.00 and includes an engraved brick installed at The Park at City Center, a certificate and a locator map.

   Commemorative Bricks are ordered twice per year, in May and in November. The cost per brick is $25.00 and includes an engraved brick installed at The Park at City Center, a certificate and a locator map.

6. May order dates: May 1-15

8. November order dates: November 1-15

10. NOTE: Orders received between order dates will be held and processed with the next brick order in May or November.

12. Brick orders take 4-6 weeks for engraving and installation.

14. Name:*

16. Address:*

18. City:*

19. State:*

20. Zip Code:*

22. Telephone Number:*

23. Email Address:*

25. Only one brick per order form, please.
    Fill in spaces with copy you wish engraved on brick. Up to 3 lines with a maximum of 14 characters each. Spaces between words, periods, commas, symbols, apostrophes, and numerals count as character spaces. Generic Symbols are available. Please double check the form for any typographical errors, as mistakes are carved in stone and cannot be corrected.

    Fill in spaces with copy you wish engraved on brick. Up to 3 lines with a maximum of 14 characters each. Spaces between words, periods, commas, symbols, apostrophes, and numerals count as character spaces. Generic Symbols are available. Please double check the form for any typographical errors, as mistakes are carved in stone and cannot be corrected.

27. Line 1:

29. Line 2:

31. Line 3:

35. Payment Information:
    Cost per brick $25.00. Debit Card service charge $1.95. Credit Card service charge $3.95.

    Cost per brick $25.00. Debit Card service charge $1.95. Credit Card service charge $3.95.

37. Fee Payment Agreement*

    Online Commemorative Brick orders require a debit or credit card payment. By checking the Payment Agreement box below, you agree for your card to be charged; upon acceptance of your brick order. You will receive an emailed receipt once your order has been processed.

    1. Payment Agreement
39. Please select:*
    -- Select One --Debit CardCredit Card

    Debit or Credit Card

40. Type of Card:*
    -- Select One --VisaMasterCardDiscover

    Visa, MasterCard, Discover

41. Amount to be Charged:
    -- Select One --$25.00

43. First and Last Name:*

    Exactly as it appears on card.

45. Credit Card Billing Address:
    Please make sure to enter the address exactly as it appears on your credit card statement.

    Please make sure to enter the address exactly as it appears on your credit card statement.

47. Address1*

49. Address2

51. City*

52. State*

53. Zip*

55. Debit/ Credit Card Number:*

    16 Digits- Enter card number

57. Expiration Date:*

    Month/Year Example: 00/00

58. Security Code:*

    3 Digits

62. Thank you for your Commemorative Brick order. You will receive an emailed confirmation once your order is received and payment has been processed. Brick orders take 4-6 weeks for engraving and installation.
    If you have any questions, please contact Heather Gaddis at 770-592-6000 x1951 or hgaddis@woodstockga.gov.

    If you have any questions, please contact Heather Gaddis at 770-592-6000 x1951 or hgaddis@woodstockga.gov.

Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field