MSSU Alumni Association

Missouri Southern Alumni - Brick Order Form

In Support of Missouri Southern State University

Online Payment Form

Important:
* Fields marked with an asterisk are required.
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Additional Options
MSSU uses PayPal services to process your credit card information securely.

Order Information

 
*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip Code:
*Country:
*Phone:
*Email:

Brick Information

The 4 x 8 brick can be imprinted with three lines of up to 15 characters per line (including spaces).
The 8 x 8 brick can be imprinted with six lines of up to 15 characters per line (including spaces) or one company logo.
Please enter (with capital letters) the name or message you would like on your brick in the boxes below, or if you have a digital black and white photo of a company logo you may upload it below.
MSSU Alumni Association reserves the right to choose the type size and arrange the words to maintain balance and improve legibility, as well as the right to work with vendors on company logos.


*Amount to pay: $
 
Billing will be handled through the MSSU Alumni Office.
 
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