Buy a Brick Form

First Name:   MI:   Last Name:
Phone:  
Email Address:
Mailing Address:   City:
State:   ZIP Code:

Brick Size:

  • Enter information in exactly as you want it to appear on your brick.
  • Leave a space between names and before and after “&”.
  • Each space counts as a character. TCC reserves the right to edit the text.
  • The text placement and color may be different from what is seen here.


Billing Information

Logos: VISA, MasterCard, American Express, Discover
Credit Card Number:  Expiration Date:  

Billing First Name:  Billing Last Name:
Billing Address:
Street:   City:
State:   ZIP Code:


Credit Card Processing