1. Bricks are $50.00 (Fifty Dollars) each.

2. The number of text line can be from 1 to 3. Text lines are limited to 15 characters or spaces per line.
          Examples:

3. $16.00 of your donation will pay for the brick, the engraving by LASER IMPRESSIONS, Sunnyvale, Ca. and shipping.

4. $50 payment for each brick is due with order. Make checks or money order payable to MVCC Brick Sales. Mail this order form and payment (no cash) to:

5. Write the text you want in the outlines below. Remember, the text lines are limited to 15 characters or spaces per line.

Purchaser: ________________________________________________________________
Street/PO Box: _____________________________________________________________
City: ______________________________ State: _________ Zip: _____________________
Total Bricks: _______ Amount Enclosed: ___________________