Military Bricks

Military Brick Order Form

"*" indicates required fields

Tribute Gift

Is this a gift?

Please note that the words "In Memory" or "In Honor" are not included on the bricks.

Check box if this gift is in honor, memory, or support of someone

This gift is

Name

First Last

Family/Honoree Notification

Please notify the family member of my gift

Family Member/Honoree Name

First Last

Family Member/Honoree Address

Street Address Address Line 2 City State ZIP Code

Message

Please let us know how you would like your name to appear on the family notification letter. Leave a comment or family message (optional)

Order a Commemorative Brick

Please note that if you are ordering a commemorative brick as a gift that the words "In Memory" or "In Honor" are not included. You will need to add it as part of the characters.

Choose a Brick size

Quantity*

You must enter the number of bricks you are ordering

Untitled

Air Force

Army

National Guard

American Flag

Marine

Navy

Coast Guard

Text Lines per Brick

4x8: 3 Lines Maximum. 20 Characters including spaces per line maximum.
8x8: 5 Lines Maximum. 20 Characters including spaces per line maximum.

Line 1

Line 2

Line 3

Line 4

Line 5

Your Details & Billing Address

Name*

Prefix First Last

Company

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

How did you hear about us?*

Please tell us

Payment Details

Credit Card Fee

$0.00

A 3.5% transaction service fee is applied for payments made using a credit card. To avoid this fee, please contact HD SOUTH directly to arrange for payment by cash or check.

Total

Credit Card Details

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name