Donation form for Pueblo a Pueblo
Fill in this form and then print it out and sign it.
Please mail this form to: Pueblo a Pueblo, Inc. · P.O. Box 11486 · Washington, DC 20008

I would like to support the T’zutujil Maya with a donation of:

$25   $50   $100   $250   $500  
$1000   $5,000    $10,000   Other   Other (please indicate amount)

Please fill in the following information to ensure accurate preparation of your tax deduction receipt:
Name:
Address:
City:
State:
Zip Code:
Telephone:
Email Address:
Please make your check payable to: Pueblo a Pueblo, Inc.. If you wish to charge
your donation to your Visa or MasterCard, please fill in the following information:

Type of Card:   Visa   Mastercard
Account #:
Expiration Date:
Name: (as it appears on your card)

Signature: __________________________________________ Date: ______________________

If you would like to make this gift in honor or memory of a relative or friend,
please complete the following:
This gift is in honor of or in memory of:
Please notify:
Name:
Address:
City:
State:
Zip Code:

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Please mail this form to: Pueblo a Pueblo, Inc. · P.O. Box 11486 · Washington, DC 20008

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