Buy-a-Brick Order Form

Enter your information and brick message. Maximum of 18 characters per line, including spaces. The more text you include, the smaller your message will appear.
Enter your message in the lines in the form below. Text will be centered on the brick. Paw prints can be added on the top line if no more than two lines of text are printed. Mark an "X" on the top line if you want a paw print. Click on the Rainbow Bridge box if you want your brick in the memorial brickway in memory of a pet who has passed. Otherwise we will place your brick in the honorary field honoring a "best friend" who walks by your side today.
Submit a new form for each brick ordered. Please indicate on the form if you will be paying by credit card or check.
To pay by credit card click on the Buy Now button below after submitting all forms or send a check to Lewes Unleashed/P.O. 406/Lewes/DE/19958

Questions can be answered by calling 202-669-7549.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Brick Line 1 - Up to 18 characters, enter X if you want Paw Print image *

Brick Line 2 - Up to 18 characters *

Brick Line 3 - Up to 18 characters *

Rainbow Bridge *

Memorial

Payment Method *

Credit Card Check

Submit