Pocket Park Brick Program Sign Up

Ordering Instructions (Please Read Carefully)

Orders must be typed completely in UPPER CASE and must fit within the space limitations specified in your product selection sheet(s). All inscriptions will be centered on the brick.

Special letters and symbols not found on a standard keyboard will incur an additional fee. Small symbols are $5.00 and large symbols are $10.00. Small symbols require two spaces. Large symbols require up to two lines.

Special instructions must be included in the NOTES field. Special instructions can include symbol placement requests, verification of spelling, or use of lower case letters for names such as McCLOUD, di ANGELO, etc.

Purchasers Name (required)

Purchasers Email (required)

Purchasers Phone

Purchasers Address (required)


Send certification of recognition to the above address? (required)

This is a gift. Send certification of recognition to the recipient below? (required)

Recipient Address (required if sending certification of recognition to address other than the one shown above)


Your Inscription (required)

Special notes/instructions

Pocket Park Brick Fees
Upon submitting this form, you will be redirected to a new area where you will be able to make your payment online. The fee to purchase a brick is $75.00.

If you have questions, please email us at or call 816-505-2227.

Validation Code (required)