Lake Superior State University
Lake Superior State University
 
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LSSU Foundation

Norris Center Plaza Paver Order Form

Personalize your Norris Center Plaza Brick!

Download the order form (pdf)

Contact and Mailing Information
Donor's First Name (required) Middle Name Last Name (required)
Address (required) Address (cont.)
City (required)State/Province (required)Zip/Postal Code (required)
Email Address (required)Daytime Phone (required)
Comments
 
Acknowledgement Information (if applicable)

If you are purchasing a brick as a gift, please enter the recipients contact information. An acknowledgement letter and their replica brick (if applicable) will be sent to them.
Recipient's First NameMiddle NameLast Name
Address Line 1Address Line 2
CityState/ProvinceZip/Postal Code
Daytime Phone
Please check this box if the brick is a surprise gift. The acknowledgement letter and replica bricks will be sent to the purchaser. If not checked, the letter and brick will be sent to the recipient of the gift.
 
Brick Order Information


NOTE: You can order up to 3 bricks (and matching number of replica bricks) with this form.
4" x 8" Brick $100 each
8" x 8" Brick $300 each
8" x 8" Logo Brick $325 each
 
Inscription
Please only use one capital letter or symbol per line. The LSSU Foundation reserves the right to approve all text prior to production. All text will be centered on each paver. Each line may contain up to 16 letters or spaces. Special letters or symbols not found on a standard keyboard may not be available.
First Brick Second Brick Third Brick
     

Line 1

Line 2

Line 3

Line 4*

Line 1

Line 2

Line 3

Line 4*
Line 1

Line 2

Line 3

Line 4*
*Line four is only available for the 8" by 8" four line message brick.
 
Total to be charged to your credit card: $
   
*
 
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