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REHOBOTH JAIL & PRISON MINISTRY

CONTRIBUTION FORM
Date:

8/18/2013

DESIGNATED FUNDS:
Contribution in support of ministry of:
To fulfill pledge for
To fulfill pledge for

(monthly).....................................$

300.00

(annual).......................................$

One-time contribution...........................................................................$
UNDESIGNATED FUNDS:
Additional contribution for REHOBOTHs general fund...........................$___100.00
TOTAL GIFT.............................$

400.00

Contributors name:
Address:
Phone number:
____________________________________________________
RECEIPT FROM:
Rehoboth Jail & Prison Ministry
c/o Terry Jordan
P. O. BOX 3
Schuyler, VA 229690003
Received:

$_____________________

Date Received:

______________________

Your Name:

_______________________________________

Stamp:

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