Instructions:

• Each brick has room for a maximum of three (3) lines with up to 23 characters per line. Spaces and punctuation each count as one character. Each line will be automatically centered.
• Bricks may be inscribed with a family name, business name,  "in memory of" or "in honor of" people, places, or pets. Dates may also be added (remember that spaces or slashes will each count as a character).
• Please note that the City of Novato reserves the right to refuse to inscribe any message that does not conform to the criteria stated above.
• Each brick purchase requires a separate form
• After submitting form, payment is by mail (check), or via the secure PayPal link provided at the end of the form.

 

Line 1 - Maximum 23 characters, including spaces, punctuation, numbers, and characters

 *

Line 1 - Maximum 23 characters, including spaces, punctuation, numbers, and characters

Line 2 - Maximum 23 characters, including spaces, punctuation, numbers and characters

Line 2 - Maximum 23 characters, including spaces, punctuation, numbers and characters

Line 3 - Maximum 23 characters, including spaces, punctuation, numbers and characters

Line 3 - Maximum 23 characters, including spaces, punctuation, numbers and characters

Please enter your full name:

 *

Please enter your full name:

Please enter your street address:

 *

Please enter your street address:

Please enter your city:

 *

Please enter your city:

Please enter State:

 *

Please select a State from the list.(Select State) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Please enter your zipcode:

 *

Please enter your zipcode:

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