Buy A Brick!

Please complete this form to order your personalized brick(s) for Grantham Village School!

Here's a few reminders:
* 3 lines of text maximum
* 15 characters maximum each line, 45 total (this includes all spaces, letters, numbers, symbols, etc.)
* All letters are printed in UPPER CASE
* All messages must be appropriate for school and will be reviewed by our committee-- please no political, inappropriate, and/or negative statements

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* 1. Last Name

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* 2. First Name

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* 3. Email Contact

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* 4. Phone Contact

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* 5. Number of Bricks and Total Amount Due ($50 each)

You will pay at the end of this survey.

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* 6. I am requesting that the bricks in this order be placed together in the project. (Note: if this box isn't checked, all bricks are placed randomly.)

Yes

N/A I am only ordering one brick.

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* 7. Brick #1 (15 characters max per line)

Row 1

Row 2

Row 3

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* 8. Brick #2 (15 characters max per line)

Row 1

Row 2

Row 3

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* 9. Brick #3 (15 characters max per line)

Row 1

Row 2

Row 3

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* 10. Brick #4 (15 characters max per line)

Row 1

Row 2

Row 3

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* 11. Brick #5 (15 characters max per line)

Row 1

Row 2

Row 3

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* 12. Brick #6 (15 characters max per line)

Row 1

Row 2

Row 3

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* 13. I would like you to email me a certificate for my order that I can give as a gift.

Yes

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* 14. Payment Method

Online (click below for secure payments through our district Stripe account)

Cash/Check (Please add name/email and send into GVS or mail to SAU 75 300 Route 10 South Grantham, NH 03753) Simply close the online payment window when it pops up if paying by cash or check.