Recognition Order Form -Indian Rocks Beach

Recognition Order Form

This is an opportunity to honor loved ones or recognize special events and occasions. Your donation is tax-deductible and will benefit either the Friends of the Library or Indian Rocks Beach City Parks.

ENGRAVED RED BRICK

Which brick would you like to purchase?

Single Brick: 4″ x 8″ (Customize up to 3 lines, 18 characters/spaces each)

Double Brick: 8″ x 8″ (Customize up to 6 lines, 18 characters/spaces each)

Placed at the City Library or Chic-A-Si Park near the Historical Museum.

Where would you like the brick placed?

City Library

Chic-A-Si Park

Brick Order Contact Information

Your Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Brick Customization

Which Brick are you purchasing?

Single Brick

Double Brick

Line 1

up to 18 characters

Line 2

up to 18 characters

Line 3

up to 18 characters

Line 4

up to 18 characters

Line 5

up to 18 characters

Line 6

up to 18 characters

Payment Information

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Processing Fee

Total

Please note: there is a $3.00 processing fee

Secure Credit Card

Card Holder*

Card Number*

Card Expiration*

Card CVV*

The City of Indian Rocks Beach reserves the right to determine the need, type, size and placement location. The City reserves the right to refuse any orders of questionable taste. The City will reasonably maintain the recognition item throughout the “life” of the product.