|
Print out this form, complete and mail to Vita
Education Services, 8 E. Court St., Doylestown, PA 18901. Thank you! |
Vita
Education Services Donor Form
| Enclosed is my gift of: ¨$1,000
¨$500
¨$250
¨$100
¨$50
¨$25
¨Other
$____
|
|
¨
Charge my gift to: ¨
VISA ¨
Mastercard #____________________________
Expiration date
_________ Signature ________________________________ |
|
¨
I prefer to make my donation in monthly installments of
$______.
¨
Charge my gift each month to: ¨
VISA ¨
Mastercard #_____________________
|
¨
I prefer that my gift to be anonymous. |
|
¨ I wish to designate my gift as a
¨
Memorial ¨
Birthday ¨
Anniversary ¨
Other
Name(s)
__________________________________________________________
Send acknowledgment to: ____________________________________________
Address ____________________________________________________
¨
My company/organization __________________________ has a Matching Gift
program. |
|
Please make checks payable to Vita Education Services.
|
Your Name(s)_______________________________________________________________________
Address____________________________________________________________________________
City
_________________________________________
State _____ Zip
code_____________
Phone: (H) _________(W) ________
E-mail address: ________________________________
A copy of the official
registration and financial information may be obtained from the PA Department of
State by calling toll free, within PA, 1-800-732-0999.
Registration does not imply endorsement.
| 
