Heritage Fund Donation Form

Full Name *

First Name Last Name

Address *

Phone Number *

- Area Code Phone Number

E-mail

Amount *

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).