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Design Your Brick from Patronicity

Help Build A Legacy

Complete this form if you purchased a brick through Patronicity. If you haven’t purchased a brick, you can now do that through our website.

Purchase Confirmation Code*

Enter the code provided to you to confirm your purchase.

Your Name*

Your Phone*

Your Email*

Brick Details

Brick Options*

Select the type of brick you purchased.

4" x 8" Brick with 3 Lines of Text

8" x 8" Brick with 6 Lines of Text

8" x 8" Brick with Logo

Brick Line 1*

Brick Line 2*

Brick Line 3*

Brick Line 4*

Brick Line 5*

Brick Line 6*

Select Logo*

Must be a 300dpi JPG file.

Accepted file types: jpg, Max. file size: 2 MB.

Complete

Comments

The submit button will appear after you enter the correct code above.

Name

This field is for validation purposes and should be left unchanged.

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