Wilcox Academy Brick Program
Posted On:
Monday, February 25, 2013

Wilcox Academy                                                                                 Commemorative Brick Program Order Form                                                  To benefit W.A.'s computer technology programs

Name:                                                                                    

Address:                                                                                 

City                              St.           Zip                           

Please print inscription as it is to appear on the brick(s):

$100 Brick       4x8  inches                                                                                                                                        Up to three lines of lettering, 14 spaces per line (including blank spaces)

Line 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Line 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Line 3 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$250 Brick                                                                                                                      8x8 inches

Up to seven lines of lettering, 14 spaces per line (including blank spaces)

Line 1 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Line 2 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Line 3 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Line 4 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Line 5 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Line 6 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Line 7 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enclosed is my check for:       $100 Brick                          $250 Brick                          Total Enclosed:                   

Make checks payable to Wilcox Academy & mail to:

Wilcox Academy, Attn: Brick Program, P.O. Box 1149, Camden, AL 36726

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