Annie’s Playground Brick Order Form
Thank you for your interest in purchasing a Memorial Brick to become a permanent part of Annie’s
Playground. Please note that on 8” X 8” bricks, up to three graphics are included in the price and will be
placed above the lettering.
Total
I would like _______ 4” X 8” bricks @ $50.00 each
(3 lines of 15 spaces)
_________
I would like ________ 8” X 8” bricks @ $100.00 each
(4 lines of 15 spaces)
*Up to three graphics free with large brick order.
_________
NOTE: Each line of text allows for 15 spaces including characters, punctuation,
and spacing.
PLEASE PERSONALIZE YOUR BRICK IN THE SPACES BELOW:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
GRAPHICS PREFERENCE (Please check)
#1. Flower _____ #2. Heart _____ #3. Butterfly _____ #4. Cross _____
Please add #’s _____ _____ _____ Graphics to my brick
PURCHASER INFORMATION:
Name: _____________________________________
Address: ___________________________________
___________________________________________
Home Phone: _______________________ Cell Phone: ______________________
Email Address: _________________________________
RETURN THIS ORDER FORM WITH YOUR CHECK OR MONEY ORDER MADE PAYABLE TO:
Pics-E Productions
MAIL TO:
PHONE:
Lorene Tompros
4004 Manor Oaks Road
Phoenix, MD 21131
410-428-6717 (Cell)
410-510-7305 (Home)
A portion of the proceeds from the bricks will be donated to Annie’s Playground for improvements
and maintenance.
Please allow 60 – 90 days for ordering and installation of your brick. You will be notified when your
brick is installed and a photo of your brick will be e-mailed to you. If any questions, please call Lorene
Tompros. Thank you for your order!
For information on Annie’s Playground at Edgeley Grove Farm Park:
www.anniesplayground.net
For information on Video Services, Tape Transfer Services, etc, and Books available for
purchase: www.picseproductions.com
The Magic of Words Collection
Written by Lorene Cumpston Tompros in Memory of her Niece
Annie McGann Cumpston
1. Trampoline Angel Annie and the Visit to Heaven
To Order: www.authorstobelievein.com
2. An Angel’s Embrace – A Journey Through Grief & Recovery
To Order: www.picseproductions.com