Contributor Form

THE HORTICULTURAL ALLIANCE OF THE HAMPTONS
PREVIEW PARTY

DONOR FORM
Please print, fill out and return this form with your payment information by mail. 

NAME* _______________________________________

ADDRESS _____________________________________
(mailing address)
BUSINESS NAME*______________________________

ADDRESS______________________________________
(mailing address)
Telephone ______________________Email _____________________________
I (We) would like to attend the Preview Party and Support HAH Programs as:

Underwriter: $1,000 _____ Benefactor: $500 _____

Sponsor: $250 _____ Patron: $150 _____
************************************************************************

I (We) would like to make payment by:

CHECK $_________.

Please make checks payable to The Horticultural Alliance of the Hamptons

and mail to P. O. Box 202, Bridgehampton, NY 11932

CREDIT CARD $____________ Please print your credit card information below.

Name (as on the card): ________________________________________

Billing address: _______________________City: ____________Zip code: ________

Type of card: Master Charge______ Visa_______

Card Number: ____________________CVV2 Code: ________ Expiration Date: ______

Signature: ________________________________________
*Please, enter name (s) as you would like it (them) to appear on the Preview Party invitation.

THANK YOU FOR YOUR VERY GENEROUS SUPPORT

%d bloggers like this: