DONATION FORM
Name: _______________________________________________________________
Address: _____________________________________________________________
City: ______________________ State: ______ Zip: ____________
Company (optional):_______________________________ Title:__________________
Telephone:__________________ Alt. Telephone:_____________________
Email Address:___________________________________________________
I wish to help the North Texas Rural Network
Community Technology Centers by donating the following:
Financial Contribution of $_________.00
Payment Options:
q Enclosed is my check (made payable to NCTC Foundation)
q Please charge to my credit card (circle one):
Card Number:__________________________ Exp. Date:_______
Equipment Donation:
q Computer Hardware (computer, monitor, printer, etc)
q Computer Software (programs, applications, etc)
q Furniture (computer desks, chairs, tables, etc)
q Office Supplies (paper, ink/toner cartridges, etc)
q Other:___________________________________________________________
Please fill out this form and mail it to
the following address:
Attn:
Scott Pulte
1525
For more information, call Scott Pulte or
Bryan Buchanan at (940)668-7731 ext 405.
The NCTC Foundation is a 501(c)(3) non-profit organization. Federal ID #75-2006921