Annie S Playground Brick Order Form

Annie’s Playground Brick Order Form

Thank you for your interest in purchasing a Memorial Brick to become a permanent part of Annie’s Playground. Please note that on 8” X 8” bricks, up to three graphics are included in the price and will be placed above the lettering. Total

I would like ______4” X 8” bricks @ $50.00 each ______(3 lines of 15 spaces)

I would like ______8” X 8” bricks @ $100.00 each ______(4 lines of 15 spaces) *Up to three graphics free with large brick order.

NOTE: Each line of text allows for 15 spaces including characters, punctuation, and spacing.

PLEASE PERSONALIZE YOUR BRICK IN THE SPACES BELOW:

______

GRAPHICS PREFERENCE (Please check)

#1. Flower _____ #2. Heart _____ #3. Butterfly _____ #4. Cross _____

Please add #’s ______Graphics to my brick

PURCHASER INFORMATION:

Name: ______

Address: ______

______

Home Phone: ______Cell Phone: ______

Email Address: ______RETURN THIS ORDER FORM WITH YOUR CHECK OR MONEY ORDER MADE PAYABLE TO: Pics-E Productions

MAIL TO: Lorene Tompros 4004 Manor Oaks Road Phoenix, MD 21131 PHONE: 410-428-6717 (Cell) 410-510-7305 (Home)

A portion of the proceeds from the bricks will be donated to Annie’s Playground for improvements and maintenance.

Please allow 60 – 90 days for ordering and installation of your brick. You will be notified when your brick is installed and a photo of your brick will be e-mailed to you. If any questions, please call Lorene Tompros. Thank you for your order!

For information on Annie’s Playground at Edgeley Grove Farm Park: www.anniesplayground.net

For information on Video Services, Tape Transfer Services, etc, and Books available for purchase: www.picseproductions.com

The Magic of Words Collection

Written by Lorene Cumpston Tompros in Memory of her Niece Annie McGann Cumpston

1. Trampoline Angel Annie and the Visit to Heaven To Order: www.authorstobelievein.com

2. An Angel’s Embrace – A Journey Through Grief & Recovery To Order: www.picseproductions.com