Purchase your brick!

MBC 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 $125.00 to MBC 5971 E Mason Lake Dr. W Grapeview, WA 98546. If you want to pay in cash, use the same process but drop the cash off with a board member or officer . Please use a separate form for each brick ordered.

Line 1
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Line 2
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Line 3
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __

If you have questions contact us at: Contact us .

Want to use PayPal to purchase your brick, see below.

Office use:
_____ Check _____ PayPal _____ Cash
_____ Ordered
_____ Picked up

Special Notes: