Federal Tax ID
# 20-1803239

Federal Tax ID
# 20-1803239

DVD Gift Contribution Form


To get your DVD gift(s) when you contribute $30.00 or more

Fill in this form and  Submit it so we can reserve your DVD and have it  packed, addresses and ready.to ship when we receive your payment/

Once you have Submitted this form you will be given instructions for payment.

     

Donor’s Name:

Donor’s Phone:

Donor’s Email:

 

Minimum Contribution level to receive a DVD

$30 -  One DVD as thank you gift.
 

 Contact Me about quantities or other questions

Don’t Contact Me

Ship To

 

    Ship to Name:

    Address

    City

    State

Country:

    Zip

 

PRINT A COPY OF THIS FORM FOR YOUR RECORDS and then Click the Submit Button below to send your order directly to us via the Internet

 

 

 

 

Copyright © 2008 - The Corneal Dystrophy Foundation.