Old Songs Contribution Form

Old Songs, Inc.
Capital Fund Drive for 37 South Main St.
Print from your browser and mail to:
Old Songs, Inc., PO Box 466, Voorheesville, NY 12186-0466
E-mail: oldsongs@oldsongs.org
For INFORMATION: 518-765-2815.
FAX: 518-765-4248

Home Address: (Please print)

    Name_________________________________________________

    Address:_______________________________________________

    City:____________________________State_____ZIP___________

    Phone: ________________________________________________

    E-mail:________________________________________________
                (for early news of events)

$25 - $49 Donor
$50 - $99 Supporter
$100 - $249 Patron

$250 - $499 Sustainer
$500 - $1,000 Benefactor
$____ . . . surprise us!

• Enclosed is my donation of $_________
Enclose check or money order made out to Old Songs, Inc.

• Please charge my contribution of $_________
Supply credit card information below.

(All donations are tax deductible to the extent of the law)

CREDIT CARD INFORMATION: Mastercard____ VISA____

Card No: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp Date: ____ /____

Cardholder's Signature

Mail to: Old Songs, Inc., PO Box 466, Voorheesville, NY 12186-0466
or fax charges to: (518) 765-4248

CREDIT CARD INFORMATION: Mastercard____ VISA____
Card No: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp Date: ____ /____
Cardholder's Signature