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Memory Bricks 

Each block will be 10  X 6 granite paver engraved with black letters.  Please be sure to print carefully so we can tell what it you want.  All  text is centered. All symbols (comma, period, dash, etc( are considered one letter. 

After filling out this form please mail or drop off

a check payable to:  Springfield Humane Society.

If you have any questions please call 802-885-2174

Cost Per Block  $200.00

16 characters maximum

Each Additional Letter  +$4.00

Memorial Brick Form

Thanks for submitting!

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