Legacy Bricks Order Form

Legacy Bricks Order Form
Husky Students,

Leave your legacy behind. Purchase your specially engraved commemorative brick to be installed in the walkway leading to the rear entrance of the school.

The brick measures 4" x 8". Contains up to 3 lines of engraved text or 3 lines of engraved text and 1 logo/symbol. There is a limitation of 18 characters per line in ALL CAPS. Please note that a grammatical symbol (period, comma, space, etc.) is a character. A Husky Logo or other symbols can be included for an additional $5. View available symbols at www.bricksrus.com/products/symbols/

Cost: $50 per brick Symbol/Logo: $5 (Only space for 1 logo per brick)
Line 1
Line 2
Line 3
Symbol or Logo
If requesting Husky Log, enter Husky Logo
Total Cost *
Acceptable Payment Options:
1. E-check or credit card via Senior Fees
2. Send cash (exact amount necessary) or check (payable to Heritage High School PTSA) to the school.
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Should be Empty: