CONTRIBUTION FORM


Please Print Clearly:

FIRST NAME: ______________________________________        LAST NAME:__________________________________________



ADDRESS__________________________________________________________________________________________________
Street                                                                City/State                                                              Zip Code


TELEPHONE NO:________________________________________CELL:_______________________________________________


E-MAIL ADDRESS:___________________________________________________________________________________________


I AM MAKING A CONTRIBUTION IN THE FOLLOWING AMOUNT:  $_____________.


MY CONTRIBUTION IS BEING MADE:         By Cash ______;        OR         By Check ______ Check No: ______




_____________________________________________________________        ________________________________________
                      Signature                                                                                                                    Date



In that the STNinJC is a non-profit organization under the Internal Revenue Service Regulation 501(c)(3),
all contributions are tax deductible.

Upon receipt of the contribution, the STNinJC will issue a letter to the contributor listing the
amount and date of the contribution for the contributor's tax records.

This Form may be printed off your computer and submitted by mail.
Make Check payable to:
STNinJC

Mail Check and Contribution Form To:  
Kristin M. Williams, Secretary STNinJC
2121 Powell Drive
Clayton, North Carolina 27520        
CONTRIBUTION FORM
SERVE THE NEED IN JOHNSTON COUNTY, INC.
What we do by ourselves matters; What we do together really makes the difference.
When We Give; We Get Back.
SERVE THE NEED IN JOHNSTON COUNTY Inc.
Post Office Box 1016
Clayton, North Carolina 27528-1016
919-550-0614
Email: info@servethe needinjc.com
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