Epiphany Catholic
Church

Washington, DC

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Epiphany Catholic Church
Memorial Garden

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Brick order form
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- How many bricks would you like to purchase: REQUIRED Please fill out this field.
  
  Brick Information 1
  
  Each 4"x8" brick can accommodate 3 lines of text, limited to 18 characters per line (including spaces and punctuation).
  
  Line 1 (limited to 18 characters) REQUIRED Please fill out this field. Please enter valid data.
  
  Line 2 (limited to 18 characters) Please enter valid data.
  
  Line 3 (limited to 18 characters) Please enter valid data.
  
  Brick Information 2
  
  Each 4"x8" brick can accommodate 3 lines of text, limited to 18 characters per line (including spaces and punctuation).
  
  Line 1 (limited to 18 characters) REQUIRED Please fill out this field. Please enter valid data.
  
  Line 2 (limited to 18 characters) Please enter valid data.
  
  Line 3 (limited to 18 characters) Please enter valid data.
- In what language would you like your brick to be engraved? REQUIRED Please fill out this field.
- Purchase Options REQUIRED 300 – 1 Brick 500 – 2 Bricks Please fill out this field.
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