Donor Form

Friends of Zoellner Arts Center Donor Form (2010-2011 Season)

NAME(S) ________________________________________________

Please print your name(s) as you wish it (them) to appear in the program.

ADDRESS _______________________________________________

CITY __________________________________ STATE____________

ZIP ____________ DAY PHONE _____________________________

EVENING_____________ EMAIL _____________________________

DONOR OPTIONS (Please circle one):
Friend $100

Patron $250

Fellow $500

Artist $1000

Maestro $2500

Producer $5000

(Your charitable tax receipt will be calculated in accordance with guidelines supporting the benefits received for your donation.)

I/we choose not to receive any donor benefits beyond program listing.
(The entire contribution will be considered tax-deductible.)

PAYMENT OPTIONS (Please check one)

Enclosed is a check, payable to Lehigh University , for $_____________________

Please charge my credit card for $ _____________________________________

Circle one: MasterCard VISA American Express

Card number ______________________________Expiration Date _______ Security Code _________

Name on card ____________________________________________________________

Signature ____________________________________________________________

Please bill me for a pledge of $_________________________________

Gift of stock: Please call the Arts Development Office at 610-758-6172.

Matching Gift: My/My spouse’s company will match my gift to the extent of

$ _______________________. (The appropriate matching gift form is enclosed.)

Payroll Deduction (For Lehigh University employees only : Download and print the “Payroll Deduction Form for Charitable Contributions.”

Fax or mail completed form to:
Zoellner Arts Center Development
27 Memorial Drive West
Bethlehem , PA 18015-3086
Tel: 610-758-6172
Fax: 610-758-5949