Thank you for your contribution to Scholarship Fund

Thank you for submitting your contribution for the students of Bethlehem.
Please print and keep the confirmation form below for your records.
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Your donation is tax deductible. Our tax exemption number is EID 23 2377526.

The Bethlehem Association Scholarship Fund,
P. O. Box 1111, MEDIA, PA. 19063, U.S.A.

I am contributing:     $ Amount    Checkone No. [Checknum]
               [Creditcard]    [Whatcard]
               [Creditname]    [Cardnum]    Exp. Date: [Mo] / [Yr]
               [Signature]       [Date]


famschol

Name:	Name
Address:	Ad1
	Ad2

Email:	Email
Phone:	DayPhone	EveningPhone	Fax
	Day	Evening	Fax
Date:	[Date2]

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	I am contributing: $ Amount Checkone No. [Checknum] [Creditcard] [Whatcard] [Creditname] [Cardnum] Exp. Date: [Mo] / [Yr] [Signature] [Date]
	famschol