Step 1 of 4 25% Name(Required) First Last Address(Required) Street Address City State / Province / Region ZIP / Postal Code Email(Required) Phone(Required) CHOOSE THE NUMBER OF BRICKS NOTE: 5 is maximum 8 x 8 x 8 Brick Size Price: 704 bricks availableQuantity of 8x8x8 Brick(Required)Please enter a number from 1 to 5.Choose a zone Zone 3a Zone 3b If you would like to see each zone click on the map below × Please add what you would like to have on the brick below. You will get a maximum of 5 lines with the first one being required. Brick size 8 x 8 x 8 Five (5) lines 14 Characters per lineBrick 1-Line 1 -- Please choose what you would like to put on the first line. If other please type no more than 14 characters(Required) PRAY FOR IN MEMORY OF BLESSINGS FROM Other Brick 1 - Line 2 (max 14 characters)Brick 1 - Line 3 (max 14 characters)Brick 1 - Line 4 (max 14 characters)Brick 1 - Line 5 (max 14 characters)Brick 2-Line 1 -- Please choose what you would like to put on the first line. If other please type no more than 14 characters(Required) PRAY FOR IN MEMORY OF BLESSINGS FROM Other Brick 2 - Line 2 (max 14 characters)Brick 2 - Line 3 (max 14 characters)Brick 2 - Line 4 (max 14 characters)Brick 2 - Line 5 (max 14 characters)Brick 3-Line 1 -- Please choose what you would like to put on the first line. If other please type no more than 14 characters(Required) PRAY FOR IN MEMORY OF BLESSINGS FROM Other Brick 3 - Line 2 (max 14 characters)Brick 3 - Line 3 (max 14 characters)Brick 3 - Line 4 (max 14 characters)Brick 3 - Line 5 (max 14 characters)Brick 4-Line 1 -- Please choose what you would like to put on the first line. If other please type no more than 14 characters(Required) PRAY FOR IN MEMORY OF BLESSINGS FROM Other Brick 4 - Line 2 (max 14 characters)Brick 4 - Line 3 (max 14 characters)Brick 4 - Line 4 (max 14 characters)Brick 4 - Line 5 (max 14 characters)Brick 5-Line 1 -- Please choose what you would like to put on the first line. If other please type no more than 14 characters(Required) PRAY FOR IN MEMORY OF BLESSINGS FROM Other Brick 5 - Line 2 (max 14 characters)Brick 5 - Line 3 (max 14 characters)Brick 5 - Line 4 (max 14 characters)Brick 5 - Line 5 (max 14 characters) PAYMENT PAGEPLEASE NOTE: You will not be able to choose your placement of your brick.(Required) I Understand How would you like to pay(Required) Cash/Check (PREFERRED) Credit Card If paying by cash or check please come to the office at your earliest convenience to pay for your total amount. Please let the administrators know your first and last name for the brick(s) you are paying for so that we can ensure they are paid. Please make check out to "St. Thomas Chaldean Catholic Church" and in the memo section please place Grotto Donation. Thank youIf you would like to help out the church and cover the 3.5% processing fees please check YES below YES CC Processing Fees Price: $0.00 Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name
