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Order Form for Bricks
Fill out the online form as indicated below

Information pertaining to the person being honored or remembered:
The first line contains the name of the veteran. Other optional information that may be included on the first line or on the remaining two lines are: rank; branch of service; dates of service; war or conflict (for example WW II, Vietnam); awards; or special recognition such as POW, MIA or KIA.
nctuation and blank
spaces count as characters.

Cost of a brick is $75.

Line 1

Line 2

Line 3
L T . J O H N O . D O E , J R .
U . S . A R M Y , 1 9 4 3 - 1 9 4 6
W W I I - B R O N Z E S T A R

Complete the lines below exactly as you want it to read on the brick. It is not necessary to center the lettering. That will be done when the bricks are engraved.

Line 1    20 spaces Max
Line 2    20 spaces Max
Line 3    20 spaces Max

Purchased by:

First Name: Last Name:
City: State:      ZIP:  
Phone: Email:  

                           2 Steps - (1) Select your method for payment  (2) Transmit Form to registration office


Select Method of Payment             

     Pay online with a Credit Card
     Mail a check
    Press "Transmit Form and Pay" to send this form and move to the payment page
Cost Total=  $



Due to volume of engraved bricks in place, we may not be able to accommodate special placement requests. 

We appreciate your interest in Veteranís Walk.
Orders for bricks will be sent to the supplier every 3 to 6 months.
We purchase our engraved bricks in larger volumes to maintain a reasonable price.
Do not think we have forgotten you. Six months is our longest schedule.