Order a Commemorative Brick

I would like to help the Charlottesville-Albemarle SPCA by buying a personalized, commemorative brick for the Sally Mead Memorial Courtyard for $250.

Name*
First Last
Company (if applicable)
Address*
Billing Address Billing Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
I would like to notify someone about my gift by email.
Enter Email Confirm Email
I would like to notify someone of my gift by mail.
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
BRICK INFORMATION - Line 1*
Please indicate below what you wish to appear on your brick. You may have two (2) lines of text, with a maximum of fourteen (14) characters per line. Spaces count as characters.
BRICK INFORMATION - Line 2
I would like:*
We will contact you with the location of your brick after it has been placed.
- my brick placed in the Sally Mead Memorial Courtyard at the SPCA.
- to be notified when my brick is ready for pick up.
Additional Notes:
Brick/Gift Amount*
Price:
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
What is your preferred method of communication from the SPCA?*
- Direct Mail
- Email