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Rehoboth Contribution Form
Rehoboth Contribution Form
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: