Online Brick Order Form Brick Information To donate a brick please fill out the form below and click submit. After submission, you will be directed to go to PayPal to make the $50 payment. *Required Purchased For* Purchased By* Address* City* State* Zip* Phone* email If this brick honors a member of the military, please indicate peace/war time & which war served: Each 4” x 8” brick can be engraved with 3 lines and 13 spaces per line. Please enter name, date, etc., as you want it to appear. One number or letter per box.* Cost per brick is $50. Donations are tax-deductible. The Andrew Jackson Higgins Memorial Foundation is a 501(c)3 organization.