____Yes,
we are pleased to support Chosen Vision, Inc. Enclosed is my gift of
________________________________.
Name: _____________________________ Street
Address:_____________________________________________
City: __________________ State: ______ Zip Code: ______________
Telephone:__________________________
__ I wish my gift to be in Memory of: ___________________or in Honor
of:
If applicable, please indicate the name and address of the person you
wish to be notified of this gift. Name:
_____________________________Street Address:
_________________________________________________
City: ______________ State: _____ Zip Code: _____________
Please charge my contribution to my personal credit card: __ VISA __
MasterCard
Card #: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp. Date:
_____ _____ _____
Signature: ____________________________ Please print name as listed on
card:__________________________
Chosen Vision, Inc. has been granted federal tax-exempt
status under section 501(c)(3) of the Internal Revenue Code. If you wish
to receive a copy of the Independent Audit and Financial Statement
prepared by Layton & Richardson, PC, Certified Public Accountants,
please feel free to contact us. Thank you for helping us to achieve our
mission.