| Your Name |
______________________________________________ |
| Your Address (Line 1): |
______________________________________________ |
| Your Address (Line 2): |
______________________________________________ |
| City |
______________________________________________ |
| State |
______________________________________________ |
| Zip Code |
______________________________________________ |
| Telephone Number |
______________________________________________ |
| Email Address |
______________________________________________ |
| Amount of Gift |
$ ____________________ |
| Comments or requests: |
______________________________________________
______________________________________________
______________________________________________
______________________________________________
|
| Make your check payable to: |
OLD WEST CHURCH - United Methodist |
| Mail your check to: |
OLD WEST CHURCH - United Methodist
131 Cambridge Street
Boston, MA 02114 |