Donations

CORPORATE DONATION FORM


Name: ____________________________________________________

Address: __________________________________________________

              ___________________________________________________

              ___________________________________________________

Contact: __________________________________________________

Address: __________________________________________________

              __________________________________________________

Phone: ___________________________________________________

Phone: ___________________________________________________

Amount:     $10,000________            $7,500________

                  $5,000_________ $2,500________

                  Other:____________________________________

                  In Kind:___________________________________

                  _________________________________________

                  _________________________________________

Tax I. D. Number:______________________________________