Burke Hospice Brick Order Form

Thank you for ordering a brick for our Tribute Garden! Your donation today will not only provide a lasting memorial to your loved one, but will help our future patients in need.

Please fill out the form completely. We accept payment via Check and Credit Card. Once you press the "Continue" button at the bottom of the page, you will see your order total on the next page.

Our Brick Choices

Tribute Wall Brick - $100 - Less than 200 slots left in the wall. Order while they last!

2-line message, 14 letters & spaces per line
Approx. 8"x2.25"
Engraving appears on the outside of the brick
Placed into the Tribute Garden walls

Pathway Standard Brick - $150

3-line message, 14 letters & spaces per line
Approx. 8"x4"
Engraving on "face" of brick
Placed on the edge of pathways around Tribute Garden or Hospice House

Pathway Paver Brick - $250

6-line message, 14 letters & spaces per line
Approx. 8"x8"
Our largest and most visible brick
Placed on the edge of pathways around Tribute Garden or Hospice House

Which brick would you like to purchase today? *

Tribute Wall Brick - 2 lines, 8"x2.25", $100

Pathway Standard Brick - 3 lines, 8"x4", $150

Pathway Paver Brick - 6 lines, 8"x8", $250

What would you like your brick to say?

Brick Line 1: * 🛈

Brick Line 2: * 🛈

Brick Line 1: * 🛈

Brick Line 2: * 🛈

Brick Line 3: * 🛈

Brick Line 4: * 🛈

Brick Line 5: * 🛈

Brick Line 6: * 🛈

Continue to the next page to enter payment information.

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