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Spruill Center for
the Arts Donation Form
DATE: - -
2009
Complete the following form, then
1. PRINT
2. SIGN
3. FAX TO: 770-394-6179
or
4. MAIL TO:
Spruill Center, 5339 Chamblee Dunwoody Road, Atlanta, GA 30338
I would like to make a tax deductible donation in the following
amount:
$
First Name:
Last Name:
Address:
City:
State:
Zip:
email:
Phone Number:
-
-
Please restrict my donation
to the following department or purpose:
I am paying by:
Check #
Make checks
payable to: Spruill Center
Credit Card
(We accept VISA, MasterCard, and Discover)
Complete the following information:
Name on Card: First
MI
Last
Billing Address (if
different from above)
Address:
City:
State:
Zip:
Card Holder Signature X__________________________________________________
Card Number---
Exp Date /
CVV#
(3 numbers on back
of card)
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