Heritage Fund Donation Form

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Date
Name *

First Name Last Name
Address *

Address Line 1

Address Line 2 / P.O. Box

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Phone Number *

Area Code Phone Number
E-mail
myname@example.com
Amount *

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USD Please enter a dollar amount (e.g. 100.00)
This donation is made in memory of or in honor of:
Notes or Special Instructions:
Thank you for your donation.

Your commitment and generosity to the Heritage Fund will help ensure the future of the Ephraim Historical Foundation.

Your gift is tax-deductible (Ephraim Foundation Heritage Fund Tax ID: 39-1743181).
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