Check for $50 enclosed for
4"X 8" brick with the following inscription: (leave blank space between names)CREATE A MEMORY ORDER FORM
To order one of these bricks/pavers by mail or fax (513-347-2644) please
print and fill out the form below.
Mail orders can be made by check or credit card and sent to Our Lady of Lourdes
Grotto , 2832 Rosebud Dr., Cincinnati, Ohio 45238 . Checks should be made payable
to Our Lady of Lourdes Grotto Fund. To order by phone, please call the
Parish Office Center, 513-922-0715. Please have your Visa or MasterCard account number and
expiration date ready.
Name______________________________________________________________
Address____________________________________________________________
City________________________________________________________________
State____________________________________
Zip______________________________________
Phone___________________________________
Check for $50 enclosed for
4"X 8" brick with the following inscription: (leave blank space between names)
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Check for $100 enclosed for
8"X 8" brick with following inscription.
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Visa MasterCard Account
#______________________ Expiration Date_____