Name:_______________________________________________
Address:_____________________________________________
City:_____________________State:______Zip:_____________
|
____ Individual ($25) ____ Family ($50)
____ Sponsor ($100) ____ Patron ($250)
|
Donation to the Nurse Homestead Restoration in the amount
of: $____________
We Accept Mastercard, Visa or Checks:
Mastercard/Visa # _______________________ Exp. Date ___________
Please make checks payable to:
Danvers Alarm List Company, Inc.
149 Pine Street
Danvers, MA 01923