Printable Form

North Country Center for the Arts

PO Box 1060, Lincoln, NH 03251
603-745-6032
email info@papermilltheatre.org

 

I would like to make a TAX-DEDUCTIBLE donation to the Papermill Theatre’s Annual Fund.

Producer…..………….$5,000 and Up                                    Stage Manager…………$250 – $499

Playwright…………..$2,500 – $4,999                                    Performer………………$100 – $249

Director……….……..$1,000 – $2,499                                    Friend……………………….up to $99

Designer…………………$500 – $999         

    

Please list me/us on the Playbill as ______________________________________________
Please do NOT list me/us on the Playbill.
My company has a matching gift program. Company name ____________________________
I have included NCCA in my will.
I wish to include NCCA in my will. Please send me suggested legal language.

 
Name ______________________________________________________________________

Street Address _______________________________________________________________

City _________________________________State _____________________Zip __________

Email ________________________________Telephone ( ______ ) _____________________

 
 I wish to pay $ ____________ now and the remaining balance in equal installments in
    the months of _____________, _____________, and _____________.

 Enclosed is my CHECK in the amount of $ _________________________________

 Please charge my CREDIT CARD in the amount of $ _________________________

 

  Visa                     Master Card                  American Express                       Discover   

 

Card # _____________________________________Exp. Date __________________________

Cardholder’s Signature ________________________________Today’s Date ________________

 

 

 

Thank you for your donation!