Our Lady of Lourdes Catholic SchoolÂ
Flame of Faith
| Mail In Form Our Lady of Lourdes Catholic Church Flame of Faith Brick Order 2200 South Logan Street Denver, CO 80210 |
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| Select Size _____ Individual Paver ($125.00 Each) 4" by 8", 3 lines of text up to 20 characters per line _____ Family Sized Paver ($250.00 Each) 8" by 8", 6 lines of text up to 20 characters per line |
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Contact Information Name ________________________________________________________ Address ______________________________________________________ City, State , Zip _______________________________________________ Email ________________________________________________________ Phone _____________________________________ Alt. Phone __________________________________ Total Amount Due ____________________ ____ By Check payable to Our Lady of Lourdes Catholic Church ____ By Credit Card (Circle One) Visa MasterCard Discover Card Number __________________________________________ Expiration Date ______________________ Indicate your brick inscription in the table below, one character per box. A character is a letter, number, punctuation mark or space. You can use up to 20 characters of mixed-case text per line or 16 characters of ALL CAPITALS per line |
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