Ambulance Fund Form

Please support the 2001 Ambulance Replacement Fund

Any donation is appreciated!

Platinum Sponsor
$ 10,000 or more

Gold Sponsor $ 5,000 to $ 9,999

Silver Sponsor $ 1,000 to $4 ,999

Bronze Sponsor $ 500 to $999

Amount of Gift Method of Payment:

Credit Card # Expiration Date:

Your Signature (for credit card): _____________________________________

Please complete the following in the event we need to contact you:

Name

Street address

City

State

Zip code

Home Phone

E-mail

Please make checks payable to: Summit Volunteer First Aid Squad.

Please print this completed form and mail to:

Summit Volunteer First Aid Squad
Ambulance Replacement Fund
P.O.Box 234
Summit, NJ 07902-0234

Thank You!

Name
Street address
City
State
Zip code
Home Phone
E-mail