Name: _______________________________________________________
Address: _____________________________________________________
City: ___________________________
State: _______ Zip Code:__________
Phone Number: ____________________________
Payment Options
My check payable to GSSSC
is enclosed.
Please charge my gift to my:
Visa
MasterCard
Card Number: ___________________ Expiration
Date: ___________
Name as it appears on Card:
________________________________________________
Card Holder’s Signature:
________________________________________________
My employer has a matching gifts
program.
Company Name: _______________________________________
Please obtain a matching gift form from
your human resources department and
return the completed form to GSSSC.
I would like to make a Tribute
gift:
My gift is:
in memory of _________________________________________
in honor of ___________________________________________
Name and Address of person receiving acknowledgement:
Name: _______________________________________________________
Address: _____________________________________________________
City: _________________________ State:
_______ Zip Code:____________
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