brick order form ronald mcdonald house near uchicago medicine comer … · 2020-02-03 · brick...
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BRICK ORDER FORM Ronald McDonald House® near UChicago Medicine Comer Children’s Hospital
To purchase a brick, please complete this order form and return it, with payment, to:
RMHC-CNI Attn: Mardelle Gundlach 5444 S. Drexel Avenue Chicago, IL 60615 [email protected] 773-324-5437
Name: ________________________________________________________________________________
Street: ________________________________________________________________________________
City, State, Zip: _________________________________________________________________________
Phone: ________________________________________________________________________________
Email: _________________________________________________________________________________
Please indicate the type and quantity of bricks you wish to order:
Full Brick: Quantity: ________ at $500 each
Half Brick: Quantity: ________ at $250 each
Total Order: $_________ for #_________ bricks
Payment Options: * Please include brick order form with your payment.
Check Please make payable to ‘RMHC-CNI’
Credit Card AMEX VISA Mastercard Discover
3-Digit Security Code: ____________________Exp. Date: ____________________
Card Number: ________________________________________________________
Signature: ____________________________________________________________
Your gift will help keep families together
Please complete your message based on the size of brick you would like to purchase.
Place one letter or punctuation mark in each box and leave blank boxes for spaces. All text will be centered. Please use a separate form to purchase more than one brick of
Your gift will help keep families together
BRICK ORDER FORM Ronald McDonald House® near UChicago Medicine Comer Children’s Hospital
Full Brick (8”x8”) 6 lines - 13 characters per line
Half Brick (4”x8”) 3 lines - 13 characters per line