<p> Annie’s Playground Brick Order Form</p><p>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</p><p>I would like ______4” X 8” bricks @ $50.00 each ______(3 lines of 15 spaces)</p><p>I would like ______8” X 8” bricks @ $100.00 each ______(4 lines of 15 spaces) *Up to three graphics free with large brick order.</p><p>NOTE: Each line of text allows for 15 spaces including characters, punctuation, and spacing.</p><p>PLEASE PERSONALIZE YOUR BRICK IN THE SPACES BELOW:</p><p>______</p><p>______</p><p>______</p><p>______</p><p>GRAPHICS PREFERENCE (Please check)</p><p>#1. Flower _____ #2. Heart _____ #3. Butterfly _____ #4. Cross _____</p><p>Please add #’s ______Graphics to my brick </p><p>PURCHASER INFORMATION:</p><p>Name: ______</p><p>Address: ______</p><p>______</p><p>Home Phone: ______Cell Phone: ______</p><p>Email Address: ______RETURN THIS ORDER FORM WITH YOUR CHECK OR MONEY ORDER MADE PAYABLE TO: Pics-E Productions</p><p>MAIL TO: Lorene Tompros 4004 Manor Oaks Road Phoenix, MD 21131 PHONE: 410-428-6717 (Cell) 410-510-7305 (Home)</p><p>A portion of the proceeds from the bricks will be donated to Annie’s Playground for improvements and maintenance.</p><p>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!</p><p>For information on Annie’s Playground at Edgeley Grove Farm Park: www.anniesplayground.net </p><p>For information on Video Services, Tape Transfer Services, etc, and Books available for purchase: www.picseproductions.com </p><p>The Magic of Words Collection</p><p>Written by Lorene Cumpston Tompros in Memory of her Niece Annie McGann Cumpston</p><p>1. Trampoline Angel Annie and the Visit to Heaven To Order: www.authorstobelievein.com</p><p>2. An Angel’s Embrace – A Journey Through Grief & Recovery To Order: www.picseproductions.com</p>