Fill in the name of the person(s) that you want us to notify that a brick has been
placed in their honor.
Name
Address
Name
Address
Brick 1
In Honor
In Memory
Bricks have up to 2 lines of text each
of which support up to 15 characters.
Line 1
Line 2
Brick 2
In Honor
In Memory
Bricks have up to 2 lines of text each
of which support up to 15 characters.
Line 1
Line 2
Your Name
Address
City
State
Zip Code
Phone #
Enclosed is $ for brick(s)
Once you have completed this form, print it out and send it to us along with your check.
Make checks payable to:
The Brethren Home Foundation
2990 Carlisle Pike
P.O. Box 128
New Oxford, PA 17350
