Brick Order Form

Name____________________________

Phone Number____________________

There is a 15 character limit per line and a 3 line limit per brick.  Please print this page, fill out below and send a check for $100.00 to MBC 5971 E Mason Lake Dr. W  Grapeview, WA  98546.  If you want to pay in cash, use the same process but instead of mailing you can drop it off to a board member or officer  .  Please use a separate form for each brick ordered. 

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