To order, please print and fill in this form and mail to:
      Pasadena Humane Society & SPCA 
      Attn: Development Department 
      361 South Raymond Avenue 
      Pasadena, California 91105

      Questions? Call 626-792-7151 x109
      or send it by email to: kympietsch@phsspca.org

Glazed ceramic tiles, permanently installed on the walls of our friend's garden, personalized with your inscription.  Please only one letter per space when filling in your tile's inscription below.

$100  Small Tile

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$400    Large Tile

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YOUR Name: __________________________________
Address: ______________________________________
City: ______________________ State ____ Zip _______
Phone: (home) _______________ (work) _____________

RECIPIENT'S Name: ____________________________
Address: ______________________________________
City: ______________________ State ____ Zip _______

Tile is... in honor of      in memory of
Name: __________________________
Is this a... person     a pet?

  My check is enclosed (made payable to Pasadena Humane Society)

  Please bill my:  Visa  Mastercard  Amex Discover

     Card # ___________________________________  Expires ______
   Verification code (found on back of card): ________

     ________________________________________
     Signature - required for charges

Thank you!