Crowder College Foundation, Inc.
A not-for-profit organization supporting the total program of education at Crowder College

2007 BUY A BRICK Form

All Fields Required

Name:

Address:

E-Mail:

Phone:

I wish to donate the following tax deductible gift:

$500 - 8" x 8" Granite Block
Six lines, up to 15 characters each (including spaces), or one logo (attach camera-ready logo)

$100 - 4" x 8" Paver Brick
Three lines, up to 15 characters each ( including spaces)

$40 - 4" x 8" Paver Brick
One line, up to 15 characters (including spaces), shared with 2 others of our choosing

The Crowder College Foundation reserves the right to choose type size and edit/arrange words to maintain balance and improve legibility, as well as the right to work with vendors on logos.

Payment Method:
Check
VISA
MasterCard
Discover

Card Number:

Name on Card:

Expiration Date:

Security Number:

Please make checks payable to:
Crowder College Foundation Brick Campaign
601 Laclede
Neosho, MO 64850

Please send a card to the following person(s) in acknowledgement of my gift.

To:

In honor of: