Buy - a - Brick Order Form 

Each brick may contain up to 18 characters per line (6” x 12” up to 3 lines of text). All text is centered and capitalized.

Engraved on your custom brick could be: 

·your family name 

·your children's names 

·your company or organization's name 

·commemoration of a special occasion 

·a memorial for a loved one 

·an inspirational message 

If you have any questions, please call 718.818.2106. 

The Richmond University Medical Center Foundation is a recognized 501(c)3 organization, Tax ID # 27-1059815. Your brick purchase is a charitable donation and is tax-deductible.