Donor Form
Friends of Zoellner Arts Center Donor Form
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 ________
Name on card ____________________________________________________________
Signature ____________________________________________________________
Please bill me for a pledge of $_________________________________
Gift of stock: Please call 610-758-5323.
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."
Mail completed form to:
Zoellner Arts Center Administration
203 E. Packer Ave.
Bethlehem , PA 18015
Tel: 610-758-5323