Donation Form

RocWheels Donation Form

Name:        __________________________________________________________________

Address:   Street / PO Box_____________________________________________________
Address:   City ______________________________State _______________Zip _________

Country:    _______________________________

Phone:       __________________________________________________________________

Email:        ______________________________________________
Yes I wish to be added to your email newsletter list.

   $350.00 Chair Sponsor. This option allows you to sponsor a ROC Chair You will receive a photograph of a child sitting in the chair you purchased for them.

   $______ Please fill in the amount of your choice.

   $15,000.00 Corporate Sponsorship

ROC Wheels is a 501 (c ) (3) Non-profit Organization

A confirmation of your gift will be mailed to you.

Please mail your donation to:

ROC Wheels

www.RocWheels.org
Andrew@ROCWheels.org
Tele. # 406 556 8065
FAX # 406 556 8197

$350.00		*Chair Sponsor. This option allows you to sponsor a ROC Chair* You will receive a photograph of a child sitting in the chair you purchased for them.**
$______		Please fill in the amount of your choice.
$15,000.00		Corporate Sponsorship