Sponsor A Puppy Form

Sponsor a Puppy - $10,000
ACTS - Assistance Canine Training Services
2928 East Conway Road
Center Conway, NH 03813
603-383-2073
info@assistancecanine.org
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Date*

MonthDayYear
Date
Contact Name*

First NameLast Name
This Sponsorship is a

Corporate or Non-Profit SponsorshipIndividual Sponsorship
Company Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Email*
example@example.com
Please Select One*

We know which puppy we want to sponsor. See below for the puppies' nameWe do not know which puppy we want to sponsor. Please choose one for us.We would like to know which puppies' are available for sponsorship.
If you have chosen which puppy you wish to sponsor please give us the puppy's name
Donation
My Sponsorship Donation*

Will be sent in one check for $10,000Will be sent in two installments of $5,000 eachWill be sent in four installments of $2,500 eachOther
Please specify the intended dates of your installments.*
Please make checks payable to ACTS.

Mail to:

ACTS
2928 East Conway Road
Center Conway, NH 03813
I acknowledge that by submitting my name and signing below, that all the above information is accurate.
Name*

First NameLast Name
Please Sign and Submit*

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Sponsor a Puppy - $10,000