Use this form for ordering a Large Brick for $75.00

When you submit the form you will be taken to PayPal to make the payment.

Your inscription for each brick must fit into one rectangle, up to a maximum of 16 characters per line. A character is defined as a letter (upper or lower case), number, blank space, hyphen, ampersand,
comma, apostrophe, exclamation point, or period. Do not use any other punctuation marks or special characters, such as % or $.

(You will be taken to PayPal to complete payment)