8/19/2019 Donation Form Andrew

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Yes!! I would like to contribute to the TALBERT FAMILY FOUNDATION,and support Andrew's Fund

ANDREW'S FUNDDONATION FORM

Name _____________________________________________________________________

Address_____________________________________________________________________

City _____________________________________ State ______________ Zip ____________

Phone (_____)____________________

E-Mail ________________________________________

I'm supporting Andrew's Fund 

Life-Changing----------------------$1,000 Valor--------------------------------$750□  Paid in full □  Paid in full

□  10 monthly payments of $100 □  10 monthly payments of $75

Celebration-------------------------$250 Journey-----------------------------$100

□  Paid in full □  Paid in full□  5 monthly payments of $50 □  4 monthly payments of $25

Mission------------------------------$50 Other Amount--------------$________□  Paid in full □  Paid in full□  2 monthly payments of $25 □  ______ monthly payments

of $____________ 

I am donating the following good/services to be used in future events:

 _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________Declared value of goods/services $_____________________

I’m paying now in full  $_________ Credit Card # ___________________Exp Date ____/_______

I’m making installment payments: Name on Card _____________________ ____ monthly payments totaling $ _________ Signature _________________________

Payments: check Visa/MC/Amex/Discover Billing Zip Code _____________________

Make checks payable to The Talbert Family Foundation

Please mail this form and check, if applicable, to:The Talbert Family FoundationAndrew's Fund

128 20th StreeetManhattan Beach, California 90266

Thank you for supporting the Andrew's Fund. Pledges are tax deductible to the fullest extent of the laTax ID #20-0330559. Donations are non-refundable.

www.TalbertFamilyFoundation.org