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Thank you for creating a lasting memory in CHR's horseshoe garden with a custom brick order. There are three brick sizes to choose from: 4x8" - $100, 8x8" - $250, and 12x12" - $1000. Text restrictions (number of characters allowed with each size) are listed below.

Bricks for Bales Order Form

Donation Amount:

$100.00$250.00$1,000.00

I would like my donation to recur:

Yes

Amount you would like to recur:

Frequency of donation:

Number of recurrences:

Date of your final recurring donation:

Open the calendar popup.

Please confirm recurring donation:

Is this brick order in honor or in memory of someone?*

This brick is in honor/memory of... (list name):

If this brick is in honor or memory of someone AND you would like CHR to send an acknowledgement to the gift recipient or memorial family, please enter the name and address here (email or physical address):

Please list the desired text to be engraved on your brick. Note: maximum number of characters including spaces for each brick size are as follows. 4x8 Brick: 3 lines, 20 characters per line (16 if all CAPS). 8x8 Brick: 6 lines, 20 characters per line (16 if all CAPS). 12x12 Brick: 10 lines, 20 characters per line (16 if all CAPS).:

I would like this order to remain anonymous:

Yes

How did you hear about us?

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Email:*

Credit Card Information

Card Types Accepted:
Visa

Credit Card Number:*

Card Security Code:*

Expiration Date:*

Electronic Signature:*

I agree to pay above total amount according to card issuer agreement. Once the transaction has completed successfully, a confirmation receipt will be sent to the email address entered.