Please detach and return this portion with your tax deductible contribution.

 

I want to help support agencies providing vital services to our community through Crook County United Fund. 

 

· Enclosed is my tax deductible contribution of $ _________________.

                                                         

                                                            OR

 

· My employer allows payroll deductions, and I authorize my employer

 

__________________________________________ to deduct $________________

 

per paycheck for _________ pay periods for a total contribution of $____________________.

 

 

Name    ________________________________________

 

Address ______________________________________

 

              ______________________________________

 

Please mail along with contribution to:

 

CROOK COUNTY UNITED FUND

PO Box 234

Prineville, OR  97754

 

 

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Retain this section for tax purposes                             

 

Amount  $_______________

 

Date _______________  Check #________

 

 

Crook County United Fund               Type 501 ( c ) (3) Non-Profit Organization

Donation Form