Brick Order Form

Express your pride and your connection to Montclair State.  Leave your mark on the campus in the serenely beautiful walkways of Alumni Green. Inscribe a brick for yourself or for someone you honor, for $100 per brick.

To order, please print out out and complete the form below and mail it, along with your payment, to:

If you wish to order more than one brick, please print out one form for each brick, but mail only one payment for the total amount.

For additional inscriptions or possible logos, call the MSU Office of Alumni Relations at (973) 655-4141.

Your Name:

Your Graduation Year (if applicable)

Address:


Phone (day):

Phone (evening):

Email Address:


I will be sending payment in the form of:
A personal check

Mastercard
Visa

Card Number:
__ __ __ __  __ __ __ __  __ __ __ __  __ __ __ __

Expiration date: ___ / ___

Name as it appears on card (please print):

______________________________________

Name or wording as you would like it to read on the brick.
Up to three (3) lines, 13 characters per line.
Spaces, punctuation marks and numbers each count as one of the 13 characters per line. (Please note: the MSU Alumni Association reserves the right to request that any inscription be amended or revised.)

First line:
Second line:
Third line:

Note: Installation of the inscribed bricks will occur only one time per year, contingent upon
meeting a minimum quantity requirement of 50 with the vendor.