Submit Printed YBR Form

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THIS FORM IS FOR USE BY VILLAGERS THEATRE STAFF, TO KEY IN PRINTED YELLOW BRICK ROAD FORMS.

YOU MUST USE THE CREDIT CARD TERMINALS IN THE BOX OFFICE, TO PROCESS ANY CREDIT CARD CHARGES.

PATRON/BUYER'S DETAILS:

First Name *

Last Name *

Phone

Street Address 1

Street Address 2

City

Zip / Post Code

A 3"x8" brick can have from 1 to 3 lines of text (inscriptions), 15 characters wide. An 18"x18" brick can have from 1 to 16 lines of text, 30 characters wide.

Type in the text that the patron specified.

If you cannot clearly read what the patron wrote on their form, first call them to confirm - before proceeding!!!
Please make sure you type EXACTLY what the patron wants engraved in their brick!

Be smart about checking for spelling. If there is a name in the inscription, does any of it match the first/last name they specified on the form? Does the spelling of a word look off? You can always check www.dictionary.com. Call the patron to verify any possible issues!

Inscription 3x8 Line 1

Inscription 3x8 Line 2

Inscription 3x8 Line 3

Inscription 18x18 All Lines Below

Brick Price

Additional Donation

Total Donation

Check Number (if paying by check)

Check Date (if paying by check)

Transaction ID (if paying by Credit Card)

Transaction Date (if paying by Credit Card)

Approval Code (if paying by Credit Card)

After clicking Confirm Order below, please wait till processing is complete.

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Submit Printed YBR Form

THIS FORM IS FOR USE BY VILLAGERS THEATRE STAFF, TO KEY IN PRINTED YELLOW BRICK ROAD FORMS.

YOU MUST USE THE CREDIT CARD TERMINALS IN THE BOX OFFICE, TO PROCESS ANY CREDIT CARD CHARGES.