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.
To print: >File>Page setup>Left margin=1.0>File>print preview>only select frame>Print
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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