411 S 2nd Ave - Mayodan, NC 27027 336.447.3873 - [email protected] www.lot2540.com Give to the Ministry of LOT 2540 To donate by check, please mail your check along with this completed form to the address above. We sincerely thank you for your gift. Donation Information I would like to make a donation in the amount of: !$1,000 !$500 !$200 !$100 !$50 !$20 !$10 !$5 ! Other: _______ ! I would like this donation to automatically repeat each month Tribute Gift ! I would like to make a donation in honor of: _______________________________________________________________ ! I would like to make a donation in memory of: _______________________________________________________________ ! Send acknowledgement via email to: Name: _________________________________________________________ Email: _________________________________________________________ ! Send acknowledgement via postal mail to: Name: _________________________________________________________ Address: _______________________________________________________ City, State, Zip: _________________________________________________ Employer Match ! My employer matches donations Donor Information First Name: _____________________________________________________ Last Name: ____________________________________________________ Phone: _________________________________________________________ Employer: Occupation: _____________________________________________________ ____________________________________________________ Email: _________________________________________________________ ! Add me to LOT’s email list ! Please do not publish my name. I would like to remain anonymous. Donor Address Address: _______________________________________________________ Address 2: ______________________________________________________ City, State, Zip: _________________________________________________ L.O.T. 2540 is registered as a 501(c)(3) non-profit organization. Contributions to L.O.T. 2540 are tax-deductible to the extent permitted by law.
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