Yes!!

I would like to contribute to the TALBERT FAMILY FOUNDATION,
and support Andrew's Fund

ANDREW'S FUND
DONATION FORM
Name _____________________________________________________________________
Address_____________________________________________________________________
City _____________________________________ State ______________ Zip ____________
Phone (_____)____________________
E-Mail ________________________________________

I'm supporting Andrew's Fund
Life-Changing----------------------$1,000

Paid in full

10 monthly payments of $100

Valor--------------------------------$750

Paid in full

10 monthly payments of $75

Celebration-------------------------$250

Paid in full

5 monthly payments of $50

Journey-----------------------------$100

Paid in full

4 monthly payments of $25

Mission------------------------------$50

Paid in full

2 monthly payments of $25

Other Amount--------------$________

Paid in full

______ monthly payments
of $____________

I am donating the following good/services to be used in future events:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Declared value of goods/services $_____________________
I’m paying now in full

$_________

I’m making installment payments:
____ monthly payments totaling $ _________
Payments: check Visa/MC/Amex/Discover

Make checks payable to

Credit Card # ___________________
Exp Date ____/_______
Name on Card _____________________
Signature _________________________
Billing Zip Code _____________________

The Talbert Family Foundation

Please mail this form and check, if applicable, to:
The Talbert Family Foundation
Andrew's Fund
128 20th Streeet
Manhattan Beach, California 90266
Thank you for supporting the Andrew's Fund. Pledges are tax deductible to the fullest extent of the law.
Tax ID #20-0330559. Donations are non-refundable.

www.TalbertFamilyFoundation.org