Step 1. To order your brick, select the size you would like to purchase from the 4 choices below.

               ___  4”x8”  (maximum 14 characters per line, 3 lines)  $100.00

               ___  8”x8”  (maximum 14 characters per line, 6 lines)  $250.00

               ___  8”x16” (maximum 14 characters per line, 6 lines)  $500.00

               ___  16”x16” (maximum 14 characters per line, 12 lines)  $1000.00

                     (company logos available on 8”x16” and 16”x16” bricks for  an additional fee)

     Step 2.  Clearly print the words you would like engraved on your brick next to the appropriate line  number. 

               Keep in mind the maximum number of characters and lines for your selected brick size.

                         All lines will be centered. Spaces and punctuation count as characters.

                                                   Please print legibly.

                                     Any order deemed inappropriate will be declined.

     Step 3.   Ordered By:

                 Name:__________________________________

                 Address:_________________________________

                 City:________________________ State:____ Zip:__________

                 Phone:__________________(only if questions arise about your order)

                To place your order mail this completed form with payment to:

                                       John Walker - American Huey 369 Inc.

                                       209 S Broadway

                                       Peru, In 46970

     Step 4.   Enclose your check or money order (no cash) made payable to American Huey 369 Inc./Gift Brick

                or include your credit card# ______-______-______-______    Exp.______   

                3 digit # _____(back of card)

                Visa        MasterCard           Discover   (we do not accept American Express)

                Signature________________________________________

                (credit card payments will be sent a receipt from American Huey 369 Inc. in 2-3 weeks)  

                                   Your donation is tax deductible.