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: