EmailMe Form - Hightstown-Apollo Lodge #41 F&AM Brick Fundraiser

Please note that payment has been disabled on this form.
You may notify the owner and continue to submit the form.

Choose Your Brick *
4” x 8” bricks can be personalized with up to 3 lines of text , 20 characters per line without clip art or 16 characters with clip art.
8” x 8” bricks can be personalized with up to 5 lines of text , 20 characters per line with or without clip art.
Click to display or hide clip art.
Please add clip art (Add $25)
Please include a Mini Replica Brick for my home or office (Add $25)
Line 1:
Line 1:
Line 2:
Line 2:
Line 3:
Line 3:
Line 4:
Line 5:
Choose Your Clip Art
Upload Your Custom Logo
Maximum File Size 5MB. Black and White 300DPI Preferred.
Name *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Phone *
### - ### - ####
Email *