THE WALLENBERG FOUNDATION OF NEW JERSEY, INC.

DONATION FORM

YES, please accept my commitment to positive change with this tax-deductible donation to The Wallenberg Foundation of New Jersey, Inc.

 $50 $100 $250 $500 $1,000 $5,000 Other $___________


          Name:

 

          Business Name (if applicable):

 

          Street:

 

          City, State, Zip:

 

          Daytime phone:

 


I/We do NOT wish to be mentioned on a published donor list.


PLEASE MAIL THE COMPLETED FORM AND YOUR CHECK (made payable to The Wallenberg Foundation of New Jersey, Inc.) to the address below:

The Wallenberg Foundation of New Jersey, Inc.
22 Route 10 West, Suite 201
Succasunna, New Jersey 07876

Thank you for your support!




 FOR OFFICE USE ONLY
RECEIVED BY _________________________________________________________ DATE ____________