| Donor Pledge
Form |
North Country
United Way
PO Box 311
Littleton, NH 03561-0311
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(603) 444-1555 Voice
(603) 444-0886 FAX |
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Name ___________________________________________________________________
Business Name (if applicable) _________________________________________________
Home Address ____________________________________________________________
City _________________________________ State _______________ Zip __________
email ___________________________________ Phone _________________________
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| Amount of gift: |
$______________________ |
| ___check |
(made payable to: North Country United Way) |
| ___bill me: |
___quarterly
___monthly |
| ___credit card |
Visa #__________________________________________
Mastercard #_____________________________________
Exp. Date: _______________________ |
signature__________________________________________
date _____________
Compensation, goods or services have not been given
by the North Country United Way in return for this contribution. |
Please print this form and Mail To:
North Country United Way
PO Box 311
Littleton, NH 03561-0311
THANK YOU!
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