Buy-A-Brick Form

Buy-A-Brick Program

Throughout the construction of each specially adapted smart home building project through our R.I.S.E. (Restoring Independence Supporting Empowerment) program, the Gary Sinise Foundation (GSF) encourages participation from the local community. One way to contribute is through our "Buy-A-Brick" program, where community members can purchase an actual brick that will be inscribed with their personal message to the family. The brick will then be incorporated into the home’s flagpole base. The donation from each brick goes directly to offset the construction costs of the specially adapted smart home.

Project/Veteran's name:

Donation Amount:

Small Brick (4 in. x 8 in.): $100.00 Large Brick (8 in. x 8 in.): $250.00

First Name

Last Name

Company/Organization

Phone

Personalized Message - (4"x 8" - 3 Lines; 8"x 8" - 6 Lines)

Line 1

Line 2

Line 3

Line 4

Line 5

Line 6

Payment Information

Card Type

VISAMasterCardDiscoverAmerican Express

Name on Card

Card Number

Code

Billing Address

First Name

Last Name

Address Line 1

Address Line 2

City

State/Province

Postal Code

Is your billing address different than your shipping address?

YesNo

Shipping Address

First Name

Last Name

Address Line 1

Address Line 2

City

State/Province

Postal Code

Deadline Information:

6 weeks before Home Dedication - brick will be installed prior to home dedication ceremony
6 week after Home Dedication - brick will be installed post home dedication ceremony

Tax Deductions:

Large Brick - $216.00
Small Brick - $76.00

If you would prefer to make your “Buy-A-Brick” donation by phone or email, please contact:

Chris Smith - csmith@garysinisefoundation.org or (573) 690-8817

Travis Reynders - treynders@garysinisefoundation.org or (314) 315-7758

Gary Sinise Foundation

P.O. Box 368

Woodland Hills, CA 91365

Contact Information