RappUnitedWay

Rappahannock United Way Logo

To place an order for a brick, complete this form. RUW Staff will review your order and contact you to confirm your desired text. If you wish to add a logo, staff will contact you for that file.

First Name

Last Name

Mobile Number

Address

City

State

Zip

Brick Options

Printed Message for Brick

4x8 Brick - up to 3 lines of 15 characters/spaces

255 character limit

0 / 255

8x8 Brick - up to 6 lines of 15 characters/spaces

255 character limit

0 / 255

This is a secure 256-bit SSL encrypted payment

Card Number

CVV

Donor hereby approves the payment of the donation and/or purchase to Rappahannock United Way and in the amount set forth herein.