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Madeira Beach, FL
2023 Resident Parking Passes Out Now
John’s Pass Village Commemorative Brick
JOHN’S PASS VILLAGE COMMEMORATIVE BRICK ORDER FORM
If ordering more than one (1) brick, bricks may be placed near each other (no guarantee); however, these bricks must be ordered at the same time. Individual bricks are rectangular (4” x 8”) in size. Each brick contains three (3) lines, with up to thirteen (13) characters per line – spaces and punctuation such as commas, periods, hyphens, etc. are also counted as one character. Any designs or symbols (hearts, crosses, palm trees, etc.) will be an additional $10.00.
Inscription Line 1
*
Required
13 characters per line
Inscription Line 2
13 characters per line
Inscription Line 3
13 characters per line
Name
*
Required
First
Last
Address
*
Required
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Required
Email
*
Required
PAYMENT
We will contact you for payment. We can take a credit card (3% fee) in person or via phone as well as a check in person or via mail.
APPLICATION AGREEMENT
To apply to sponsor a brick, please read the terms and conditions below. Please sign at the bottom and return with the sponsorship fee and order form.
1.) The City of Madeira Beach reserves the right in its sole discretion to deny application on any brick or refund any sponsorship fee. If this application is accepted, we will arrange for your inscription to be placed on a brick. The application shall only be considered accepted when the brick is installed.
2.) A party or parties who apply to sponsor a brick are individually and collectively referred to in this agreement as “Sponsor”. Sponsors shall have no control over the location of brick or date of its installation.
3.) Sponsors agree that access to the pavers may be discontinued or interrupted, all without liability of the Sponsor.
4.) Sponsors shall have no control over the design, format, material, appearance, construction, manufacture, installation, maintenance, repair, admission or access to, or operation of the brick or pavers. Sponsors recognize that the brick may chip, crack, wear or otherwise become damaged due to any cause. Sponsors will not have the right to require that the brick or pavers be maintained, repaired, removed, or relocated.
I have read and understand the terms of the John’s Pass Village Commemorative Brick – Application Agreement.
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Required
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