Cash donation levels to choose from

Donor/Business Name: ___________________________________________________

Catalog Credit: ________________________

Address: __________________________________________________________________________________________________________ Contact Person: ____________________________________________

Authorized Signature: ______________________________

Phone: _______________________ Email: ____________________________ Web Address: _________________________________

Cash donation levels to choose from: Underwriter ($2,500 - above)

Patron ($1,000 - $2,499)

Benefactor ($500 - $999)

Sponsor ($250 - $499)

Friend ($1 - $249)

Cash donation amount: $______________ ___ Paid by enclosed check (made payable to Beauvoir Scholarship Auction) ___ Paid by Credit Card (Visa/MasterCard) Card #: ___________________________________ Expiration: ___________________ Security Code: ____________ Name on Card: _____________________________________________________________________________________ Authorized Signature: ________________________________________________________________________________ DEADLINE FOR DONATIONS TO RECEIVE CATALOG CREDIT: February 10, 2017 Beauvoir Scholarship Auction 3500 Woodley Road, NW, Washington, D.C. 20016 Phone: 202.537.6513 TAX ID# 8661-14717-01

Fax: 202.537.6512 Email: [email protected] Please keep a copy of this form as an initial receipt.