Alumni Plaza Brick Order Form

Please complete the form below to order a brick to be placed in the Alumni Plaza using your credit or debit card. To pay by other methods, please use the printable brick order form to place your order.

All proceeds from your brick purchase will go to the Ozarks Annual Scholarship Fund.

Brick Information

Please enter the name as you want it engraved on the brick. You may enter approximately 75 characters total.

First name:
Middle name or initial:
Last name:
Last name suffix:
Gift Type:

Alum's Class Year:
Brick Amount: $
Additional Gift Amount: $
Cardholder Information
* First name:
* Last name:
Country:
Address:
City:
State:
Postal Code:
Email Address:

To receive an electronic confirmation for your brick order, you must enter your email address.

Phone Number:
 -  - 
Card Information
Accepted card types
* Credit Card Type:
* Credit Card Number:
        
* Expires:
  
* CCV Code:
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