Paving the Path to The Chai Center
Brick Order Form

The Chai Center was founded on the idea of community. We invite you to become part of that tradition. With a single step... Enhance our building and help us expand our enriching programs.

Your personalized brick will pave the way to The Chai Center.

Tribute Ideas:
Anniversary ~ Birthday ~ Company ~ Get Well ~ Graduation
In Memory ~ In Honor ~ Thank You ~ Wedding

Pricing for bricks: 1 brick ........... $250 2 colored brick ............ $350


Inscription to be engraved as follows: Up to 13 characters per line, up to 3 lines per brick
Line 1
Line 2

Line 3


Purchased by:
Name
Last Name
Address
City, State, Zip
Phone Number


Method of Payment: Credit Card or
Please bill me at the above address

Credit Card Number
Expir. Date
Name on card
Total to be charged to card
Billing Address Billing Zip Security Code

* For multiple orders, please reuse this form.