Brick Order Form

Please print this form and mail it to:

Friends of the Brandywine Hundred Library
1300 Foulk Road
Wilmington, DE 19803

YES, I want to support the Library with
my gift of ____bricks at $100 each.

Engraving Instructions: Maximum 3 lines,
14 characters per line including spaces and punctuation.
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _
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For additional bricks, please use reverse

Payment information:

__  I am enclosing my check in the amount of $_________,

payable to "Friends of BHL"

__  I'm not interested in giving a brick at this time,
but I would like to donate: $_______

Corporate Matching Gift programs can multiply the
impact of your gift.  Your donation is tax-deductible.

Name: _____________________________
Street: _____________________________
City: _______________State___Zip______
Phone: _____________Email____________

Thank You!
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