ASALH 360 Scholarship Donation

360 SCHOLARSHIP DONATION FORM

ASALH
Name

First Name Last Name
Shipping Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Phone Number

Area Code Phone Number
Donation Selection - Please note a convenience fee is being charged to cover our cost.
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Monthly Donation ( $ 31.00 for each month )
Your $31 donation will be automatically charged monthly via PayPal on the credit card you have provided for 12 months.

Quarterly Donation ( $ 92.50 for each three months )
Your $92.50 donation will be automatically charged every 3 months via PayPal on the credit card you have provided for 12 months.

Annual Donation ( USD for each year )
Your $370 (or higher designated) donation will be automatically charged annually via PayPal on the credit card you have provided.
If you prefer to mail your donations each month/quarter/year
please send checks to:

360 Scholarship Donation
Manasota ASALH, Inc.
P.O. Box 2356 SARASOTA, FL 34230 US

Please write check out to: 360 Scholarship Donation.

PLEASE NOTE:

For mailed in checks only:

Please down load the form, fill it in and mail it with your check.
Click Here to download the form.

Thank you for your support!
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