Brick/Paver Form

Once you complete this form, we will be in touch to obtain a digital copy of the photo you would like to use for your Pet Tribute Plaque. To expedite the process, you may also reply to the confirmation email you'll receive once you've completed this form with your photo file attached.

Plaque Information

Amount

Please enter the text you would like added to your Pet Tribute Plaque.

Plaque Text

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

Zip/Postal Code

Home Phone

Cell Phone

Work Phone

Help Us Cover Costs

Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.

Yes! I want $150.00 to go to Blue Ridge Humane Society and I will donate $154.50.No. I will donate $150.00 and Blue Ridge Humane Society will cover the processing costs.

Credit Card Information

Card Holder Name

Card Type

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

City

State/Province

Zip/Postal Code

Privacy Policy
We keep your personal information private and secure. When you make a payment through our site, you provide your name, contact information, payment information, and additional information related to your transaction. We use this information to process your payment and to ensure your payment is correctly credited to your account.

Blue Ridge Humane Society is a nonprofit 501 c3 animal welfare organization and limited admission shelter whose mission is dedicated to ensuring the highest quality of life for animals in Henderson County and our neighboring communities through adoption, outreach, and education.

Federal Tax ID: 56-6048726

www.blueridgehumane.org