BarkPlace Custom Brick Order Form

Mail-in Order Forms

If you wish to pay via check, please complete and mail-in one of the following order forms:

4" x 8" Printable Order Form
4" x 8" with Clip Art Printable Order Form
8" x 8" Printable Order Form
8" x 8" with Clip Art Printable Order Form

Online Form

If you wish to pay via PayPal or credit/debit card, please complete the following form.

Personal Information

Full Name

Address

City

State

Zip Code

Phone

Brick Details

There are four commemorative bricks available to purchase. Depending on the brick type selected, you will be able to add a few lines of text and clip art.

Bricks are automatically centered, Top to Bottom and Left to Right.

Brick type* 4" x 8" 4" x 8" with Clip Art 8" x 8" 8" x 8" with Clip Art

Brick text*

Please proofread before submitting!

Please select a brick type to see text options.

Clip art* Paw Print Heart American Flag

Clip art location* Left Right

Clip art* Paw Print Heart American Flag

Clip art location* Top Bottom

Choose a Payment Option

Price: Please select a brick type to see the price.