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Heritage House Donation Form Doc 10-02-12

Heritage House Donation Form Doc 10-02-12

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Published by The News-Herald

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Published by: The News-Herald on Oct 22, 2012
Copyright:Attribution Non-commercial

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10/22/2012

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www.chardonheritage.org
Chardon Heritage House Donation Form
Donor Information (please print or type)
NameBilling addressCityStateZIP CodeTelephone (home)Telephone (business)FaxE-Mail
Contribution Amount $____________ in the form of:____ cash ____ check ____ PaypalAcknowledgement Information
Please use the following name(s) in all acknowledgements:
Signature(s): ____________________________________ Date: __________________________ 
Please make checks payable to:
City of Chardon – Heritage HouseMail to:
Heritage House c/o Diane Blanchard10530 Pinegate Dr.Chardon, OH 44024
 Thank you for caring about your community. We look forward to partneringwith you to strengthen the heart of Chardon and give the people of GeaugaCounty a new resource that builds pride, energizes the economy, and createsopportunities for all.

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