Engrave a Brick Donation Form – Westhampton Beach Historical Society

THANK YOU FOR CONTRIBUTING TO OUR ENGRAVE-A-BRICK FUNDRAISER!

Pave the way and be a part of history:

Recognize that special person or pet in your life with an engraved brick
Pay tribute to loved ones for generations to see.
Promote your business or profession.
Give the perfect gift or special memento.
Recognize your special affiliation or membership.

Cost is $250 per brick

Name(Required)

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Email(Required)

Engraving

Line 1(Required)

Line 2

Line 3

Donation Amount

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Brick Picture for Website

Thank you for supporting our Community Education and Historic Preservation programs!

A 501(c)(3) non-profit organization. All donations are tax deductible.