1. No category

On the Wall, City! Order Form
Fill in your personalised brick details
Please print in block capitals. Remember to include spaces between words. Maximum of 16 characters per line. Each letter,
number, space or punctuation count as one character.
Single Brick - £50 each (2 lines)
Brick One
Gold lettering
Black lettering
} Please tick only one
Two lines of text each line. NO more than 16 characters.
1.
2.
Gold lettering
Black lettering
Brick Two
} Please tick only one
Two lines of text each line. NO more than 16 characters.
1.
2.
Double Brick - £100 each (2 lines)
Brick One
Gold lettering
Black lettering
} Please tick only one
Four lines of text each line. NO more than 16 characters.
Gold lettering
Black lettering
Brick Two
} Please tick only one
Four lines of text each line. NO more than 16 characters.
1.
2.
3.
4.
1.
2.
3.
4.
Your details
Your payment details
Name:
Credit card
Address:
Switch card issue number:
Valid from:
Postcode:
Daytime telephone number:
E-mail address:
Customer No:
From time to time we may mail, email or telephone you with details of other
offers from ourselves or carefully selected third parties that may be of interest to
you. Please tick the box if you do not wish to receive these.
Cash
/
Cheque
Expiry date:
/
Card number:
Cardholders signature:
Number of single bricks @ £50 each
Number of double bricks @ £100 each
Total value of order £_______
Please make cheques payable to Norwich City Football Club
Please send your completed order together with payment to: Lotteries Department, Norwich City
Football Club, Carrow Road, Norwich, Norfolk, NR1 1JE.
Call 01603 218 710 or log on to www.canaries.co.uk
Terms and conditions:
1. The brick remains the sole property of Norwich City Football Club. 2. The bricks will be installed on a first-come, first-served basis at the discretion of the Club. 3. Bricks
may become worn or damaged due to natural causes without liability to the Club. 4. The Club reserves the right to refuse unsuitable inscriptions. 5. In exceptional
circumstances the bricks may be removed or relocated by the Club without liability for replacement.