ATA Brick Purchase Registration

 

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First Name:*
Last Name:*
Address:*
Cell Phone #:*
Home/ Work Phone #:
Email Address:*
 

Purchase Fee:

$100.00 USD for 4" x 8" Brick
;   $150.00 USD for  8" x 8" Brick;   $250 for 12" x 12" Brick;    $350.00 USD for 12" x 12" Porcelain Tile.

 
Method of Payment:*


 
  • For a 4" x 8" brick, a maximum of 3 lines of 20 characters each is allotted.
  • For a 8" x 8" brick, a maximum of 6 lines of 20 characters each is allotted.
  • For a 12" x 12" brick, a maximum of 8 lines of 20 charachters each is allotted.
  • For a 12" x 12" porcelain tile, a maximum of 8 lines of 20 characters each is allotted.
 
 

Print the information exactly as you wish for it to appear.  Note: Spaces & punctuation are counted as characters.

If any errors have been made and the form has been submitted, you have 24 hours from the time of submission  to notify us at info@anguillatennis.com with the correction. Failure to submit corrections within the given 24 hour period, will result in the brick/tile being printed as submitted.

 

Brick/Tile Size*






 
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I acknowledge that all information entered is accurate:*