BELLPORT HIGH SCHOOL ATRIUM
BUY-A-BRICK PROGRAM ORDER FORM
You can purchase a brick to honor or to remember. A brick will last a lifetime AND helps with the ongoing beautification of the gardens in the atrium at Bellport High School.
Bricks are top-quality Cambridge pavers, engraved by hand by a local craftsman, and enhanced with black engravers paint for maximum impact and durability.
NAME OR MESSAGE:
Please print EXACTLY as you would like it to apprear on your brick. Up to 14 characters per line, 3 lines maximum.
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YOUR INFORMATION:
Name: ______________________________________________________________________________________
Address: ____________________________________________________________________________________
Phone: __________________________________ (home) ________________________________________ (cell)
Email: ______________________________________________________________________________________
Please attach a check in the amount of $50.00, Pay to the order of Bellport High School PTSA. Write Atrium Brick in the memo.
Drop off at the high school main office (PTSA Mailbox) or mail to:
Bellport High School PTSA
205 Beaver Dam Road
Brookhaven, NY 11719
Thank you. The PTSA appreciates your support.
Bricks are top-quality Cambridge pavers, engraved by hand by a local craftsman, and enhanced with black engravers paint for maximum impact and durability.
NAME OR MESSAGE:
Please print EXACTLY as you would like it to apprear on your brick. Up to 14 characters per line, 3 lines maximum.
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _
YOUR INFORMATION:
Name: ______________________________________________________________________________________
Address: ____________________________________________________________________________________
Phone: __________________________________ (home) ________________________________________ (cell)
Email: ______________________________________________________________________________________
Please attach a check in the amount of $50.00, Pay to the order of Bellport High School PTSA. Write Atrium Brick in the memo.
Drop off at the high school main office (PTSA Mailbox) or mail to:
Bellport High School PTSA
205 Beaver Dam Road
Brookhaven, NY 11719
Thank you. The PTSA appreciates your support.