FZZAV000
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Gift Information |
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| Donation Amount: $ 1874.62 | ||||||
| Designation: Hurricane Katrina | ||||||
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Please check that your name and address are
correct |
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| Today's Date: Sunday, October 9 , 2005 | ||||||
| Name: E.T. Samples, President | ||||||
| Company/Organization: Redland District Lions Club | ||||||
| Address: P.O. Box 700196 | ||||||
| City: Goulds | State: Florida | ZIP: 33170 | ||||
| Country: US | ||||||
| Telephone Number: 305.247.3721 | ||||||
| Email Address: ets@lewiselec.com I may be contacted by e-mail. | ||||||
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Check or Credit Card information. |
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| Please make checks payable to American Red
Cross. If you wish to use a credit card, please complete the
information below and mail in this form to the address listed at
the top of this page. Thank you for your support. |
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| Name on Card: | ______________________________________________ | |||||
| Card Type: | ______________________________________________ | |||||
| Account #: | ______________________________________________ | |||||
| Expiration Date: | ______________________________________________ | |||||