Building a Legacy
Brick by Brick

Online Order Form
(To access the St. Luke's Employee Order form click here)

To place your order online, please provide the information requested below or: click here to download a printable order form to order by mail or fax.

Step 1: Order

Number of Bricks:

Engraved Brick
x $100 each

Replica Brick
x $50 each

(Replica Brick(s) ships in 6-8 weeks to shipping address specified in Step 3)

Inscription Guidelines:

  • 16 characters per line maximum, including spaces and punctuation marks. You may use any symbol on a standard computer keyboard.
  • Inscriptions will communicate non-commercial messages only. Company names can be used. Phone numbers, e-mail and web addresses, slogans, sales pitches, and logos cannot be used. We cannot guarantee location of your brick.
  • St. Luke’s reserves the right to approve all text prior to inscription.
  • You will receive a confirmation letter in 2-3 weeks to review the imprint as it will appear on your brick.

My Brick Should Be Inscribed as Follows:

Line 1:

Line 2:

Line 3:

Proceed to Step 2: Verify Amount/ Inscription


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