Beccs 'Buy-a-Brick' Campaign

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Beccs 'Buy-a-Brick' Campaign

Payment Details
Beccehamian RFC Extension Account
·         Account Number: 85282758
·         Sort Code: 60-23-22
·         Reference: Please use ‘BaB’ followed by your name eg/ BaB P Broadhurst

Once you have completed this form, please send payment to the above account. If you plan to pay in instalments, or can not yet pay, please email Paul at beccsbuild@gmail.com with details.

What is your name? *

What is your email address? *

Which section of the club are you part of? *

Minis (Micro - U11)

Junior Girls & Boys (U12 - U18)

Adult Playing - Men & Women

Social Member

Other:

Which brick do you want to purchase? (1 per form) *

A1 - Small - Charcoal Brick - White Writing (Max 2 lines of text) - £100 min.

A2 - Small - Terracotta Brick - White Writing (Max 2 lines of text) - £100 min.

A3 - Small - Stone Brick - Black Writing (Max 2 lines of text) - £100 min.

B1 - Medium - Charcoal Brick - White Writing (Max 4 lines of text) - £200 min.

B2 - Medium - Terracotta Brick - White Writing (Max 4 lines of text) - £200 min.

B3 - Medium - Stone Brick - Black Writing (Max 4 lines of text) - £200 min.

C1 - Large - Charcoal Brick - White Writing (Max 6 lines of text) - £300 min.

C2 - Large - Terracotta Brick - White Writing (Max 6 lines of text) - £300 min.

C3 - Large - Stone Brick - Black Writing (Max 6 lines of text) - £300 min.

What message do you want on the brick? (16 Characters per line, please use 'ENTER' to start a new line. Punctuation and spaces count as 1 character) *

How do you intend to pay for this brick? *

One-Off Payment

Instalments

If you plan to pay in instalments, please specify how much and how often.

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