Purchase a Tribute

Bricks or butterflies can be purchased or renewed (renewal for butterflies only) using the form below. Please fill out a separate order form for each purchase. Agrace will send you a letter confirming the text to be engraved on your butterfly or brick. If you have questions or would like a mailed form, please contact the Agrace Foundation at giving@agrace.org or (608) 327-7180.

"*" indicates required fields

Campus Location:*

Madison

Janesville

Please start by choosing which campus you'd like for the location of your tribute.

Type of Memorial Tribute:

Brick

Butterfly

Brick Order Information

Select Brick Size:*

(Select your brick size)4" x 8" brick ($750)8" x 8" brick ($1,500)

Enter text to be engraved:

3 lines of engraving with 13 characters per line. Punctuation and spaces count as characters.

Enter text to be engraved:

6 lines of engraving with 13 characters per line. Punctuation and spaces count as characters.

Text in ALL CAPS (optional):

Yes. Engrave my text in ALL CAPS

Honoree's Name:*

Speaker notes:

The honoree’s name may be read aloud at the ceremony. If this name is often mispronounced, please write pronunciation notes here. (e.g., Agrace = Uh-grace, Andrea = on-DRAY-uh)

Butterfly Order Information

Select Butterfly Size or Renew:*

(Select your butterfly size)3-inch Bronze acrylic butterfly ($150)4-inch Silver acrylic butterfly ($250)5-inch Gold acrylic butterfly ($500)One-year renewal of any size butterfly ($150)

I’m dedicating this butterfly:

In honor of

In memory of

Honoree's Name (to be engraved on butterfly):

Enter the name(s) to be engraved on your butterfly. Punctuation and spaces count as characters (20 characters maximum).

Speaker Notes:

The honoree’s name may be read aloud at the ceremony. If this name is often mispronounced, please write pronunciation notes here. (i.e., Agrace = Uh-grace, Andrea = On-dray-uh)

Donor Information

First Name:*

Last Name:*

Address For:*

Home

Work

Address:*

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Phone:

Email*

Would you like someone else notified of your gift?

Yes, please notify the below person(s) of my gift.

Name of person(s) to notify:

Address:

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Payment Information

Your transaction is taking place on this secure web site and your information is encrypted for security.
Agrace does not sell or share your personal information to third parties for any reason without your explicit consent.

We accept Visa, MasterCard, and Discover.

Transaction Fee

Yes! I’d like to cover the 3% transaction fee

Transaction Fee

Price: $0.00

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date

Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044

  Security Code Cardholder Name

Submit