Federal Tax ID
# 20-1803239

Federal Tax ID
# 20-1803239

2007 DVD Gift Contribution Form


To get your 2007 DVD gift(s),

Fill in this form and  Submit it so we can reserve your DVD and have it  packed, addresses and ready to ship when we receive your payment/

Once you have Submitted this form you will be given instructions for payment.

     

Donor’s Name:

Donor’s Phone:

Donor’s E-mail:

 

 

 Contact Me about quantities or other questions

Don’t Contact Me

Ship To

 

    Ship to Name:

    Address

Address 2

    City

    State

Country:

    Zip

 

PRINT A COPY OF THIS FORM FOR YOUR RECORDS and then Click the Submit Button below to send your order directly to us via the Internet

 

 

 

 

Copyright © 2011 - The Corneal Dystrophy Foundation.