Wilcox Academy Commemorative Brick Program Order Form To benefit W.A.'s computer technology programs
Name:
Address:
City St. Zip
Please print inscription as it is to appear on the brick(s):
$100 Brick 4x8 inches Up to three lines of lettering, 14 spaces per line (including blank spaces)
Line 1
Line 2
Line 3
$250 Brick 8x8 inches
Up to seven lines of lettering, 14 spaces per line (including blank spaces)
Line 1
Line 2
Line 3
Line 4
Line 5
Line 6
Line 7
Enclosed is my check for: $100 Brick $250 Brick Total Enclosed:
Make checks payable to Wilcox Academy & mail to:
Wilcox Academy, Attn: Brick Program, P.O. Box 1149, Camden, AL 36726