Tiger Bricks Sign Up Form

Complete the form below to order your Tiger Brick.

When completing the inscription, leave a space between names and before and after "&"

Greek letters are available

If this order is a gift, please include the name and address of the person to whom a certificate should be mailed.

Purchaser's Name:     Phone:

Email:

Address:

City:     State:     Zip:

Payment Details

First Name (as it appears on card):     Last name:

Credit Card Type:

Card Number:     Exp Date:  /

Security Code:

LSU Alumni Association reserves the right for copy approval/refusal
$100: 4" x 8" Tile
15 characters per line
3 lines maximum
$200: 8" x 8" Tile
15 characters per line
6 lines maximum
$300: 8" x 8" Tile
15 characters per line
4 lines maximum
(LSU logo included)

Gift to:

Address:

City:     St: Zip:

 

© Copyright 2012, LSU Alumni Association. All rights reserved.


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