Crimson Promenade

Please complete all sections of this form. Complete and submit one form for each paver. If you have
any questions, please call the Crimson Promenade office at (205) 348-3326 or email crimson.promenade@sa.ua.edu.

You will receive a certificate to give to the person honored or to a loved one of the individual you are remembering with your gift.

DONOR AND PAYMENT INFORMATION

Donor information must be filled in completely. Payment of $100 per brick will be charged to your credit
card. Your contribution is tax deductible to the full extent allowed by law.

*If you wish to print this order form click here

Prefix
First Name	*
Middle Name
Last Name:	*
Suffix
Address line 1:	*
Address line 2:
City:	*
State:	*
Zip:	*
Home Phone: (xxx-xxx-xxxx)	*
Daytime Phone: (xxx-xxx-xxxx)	*
E-mail Address:	*
I am a: *	UA Alumnus/a
	UA Student
	UA Faculty of staff member
	Friend of the University
	Parent/Gaurdian
Year Graduated (if applicable):

Is your donation in honor of someone?	Yes No *
Honoree Name (if applicable):

Is a company matching your donation?	Yes No *
Company Name (if applicable):

BRICK PAVER TEXT
Following the instructions below, fill in the text you would like engraved on your brick paver. Finished
pavers will measure eight inches square.

Optional: Choose an affinity group to associate your brick with

PAVER TEXT

Beginning in the first block of each row, fill in the text you want to appear on your brick paver.

You may use Greek capital letters, numbers, spaces and the following punctuation marks: period, comma,
dash, slash, ampersand (&), apostrophe, quotation marks, colon, semicolon, parentheses, question mark
and exclamation point.

All text will be centered on the finished paver. Each line may have up to 14 characters. Each letter, digit, space and punctuation mark counts as one character.

Choosing the "Text" option and leaving the field "BLANK" or empty will result in a blank line on your paver.

Examples: In honor of, In memory of, An Affinity Group

First Line: *	Text	Examples: In honor of, In memory of, An Affinity Group
	Or...
	Greek Letters

Second Line: *	Text
	Or...
	Greek Letters

Third Line: *	Text
	Or...
	Greek Letters

Fourth Line: *	Text
	Or...
	Greek Letters

Additional Notes/Comments: