1.
Name:
2.
Street Address:
3.
City:
4.
State:
5.
Zip Code:
6.
Phone Number:
7.
Email address:
8.
Church Envelope Number (if you have one)

Please identify how you would like your contribution allocated:

9.
General Fund - Amount
10.
Settlement Fund - Amount
11.
Building Fund - Amount
12.
Designated Fund - Amount (specify designated fund next to amount)
13.
Designated Fund - Amount (specify designated fund next to amount)
14.
Other - Amount (please specify designation)
15.
* TOTAL CONTRIBUTION AMOUNT:

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