Please accept: MY GIFT in the amount of $____________ or STOCK CERTIFICATES in the amount of $____________ or A GIFT in the amount of $____________ on behalf of (name) ______________________________ or A PLEDGE in the amount of $_______________ paid in 1 2 3 installments on dates: First date ____________ Last ____________ Name:___________________________________________ Phone:_______________________ Address:______________________________ City:____________________ State:__________ Zip:__________ Signature:________________________________________ Make checks payable to FoWB / Ellwood and mail to P.O. Box 576, Locust Grove, VA 22508. FoWB is a not-for-profit 501 (c)(3) organization, tax ID #54-192095. |