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Humane Society of Pagosa Springs
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MEMORIAL BRICK DONATION FORM
Fill out form, print page, and send (payable to Humane Society of Pagosa Springs if paying by check) to:

   HSPS
   PO Box 2230
   Pagosa Springs, CO 81147

Donation Amount: ($100 or above)
 
In Memory Of:
(Name)
 
Memorial Brick Inscription - 3 lines, 20 characters per line (optional laser "paws" takes 4 characters)

(Line 1)
(Line 2)
(Line 3)
(The versatility of laser engraving lets us put 20 characters per line on a 4" x 8" brick with 3 lines per brick standard. Also a laser "paws " can be placed on your memorial brick. The "paws" takes the space of 4 characters.)
 
Donor Name:
Donor Address:
Donor City:
State: Zip:
Donor E-Mail:
 
Charge to: Mastercard   Visa 
  American Express   Discover 
Name on Card:
Credit Card #:
Exp. Date:
Web Hosting Donated by Electric Sage
- Animal Shelter -
Hours: Mon.-Sat. 10am-5pm, Sun. 10am-4pm
Address: 465 Cloman Blvd., PO Box 2230,
               Pagosa Springs, CO 81147 (Map)
Phone: (970)731-4771 FAX: (970)731-5552
E-mail: sheltermanager@humanesociety.biz		 - Thrift Store -
Hours: Mon.-Sat. 9 am-6 pm, Sun. 10 am-5 pm
Address: 269 Pagosa St on Hwy 160, PO Box 2230,
  Pagosa Springs, CO 81147 (Map)
Phone: (970)264-6424 FAX: (970)264-5593
E-mail: hsthriftstore@humanesociety.biz		 - Administrative Office -
Hours: Mon.-Fri. 8am-5pm
Address: 269 Pagosa St on Hwy 160, PO Box 2230,
  Pagosa Springs, CO 81147 (Map)
Phone: (970)264-5549 FAX: (970)264-5593
E-mail: hsadmin@humanesociety.biz