DonationBricks.com Website Setup Form

Organization Name:*

Contact Person Name:*

Contact Person Email:*

Contact Person Phone:*

Street Address:*

City:*

State/Province:*
[Choose One] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming ——— Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan

ZIP/Postal Code:*

Payment Type:*
[Choose One] PayPal only Check only PayPal and check

Domain Name:*

Foreground Color:*
[Choose One] Aqua Beige Blue Gold Gray Green Lavender Orange Peach Pink Purple Red Sage Silver Sky Blue Teal White

Background Color:*
[Choose One] Beige Black Blue Brown Charcoal Gold Green Hunter Maroon Navy Orange Pink Plum Red Rose Silver Tan Violet Yellow

Organization Logo:

To add your logo to the website, email it to engrave [at] giftbricks [dot] com after completing and sending this form. Make sure you include in your email message the same Organization Name and other contact information you entered above so we can match it to your request—and can follow up, as needed.