Document 420530

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 Please do not publish my name.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.