Donation Form

Fuel Up at Perry Harrison School

Donation Amount $ ______________

First Name _________________________________________________________

Last Name _________________________________________________________

Street Address ______________________________________________________


City ______________________________________ State ______________ Zip Code _______________

Phone Number _______________________________

E-mail ______________________________________

*** Please make your check payable to "Fuel Up at PHS"***

Mail this completed form and your donation to:

Fuel Up at Perry Harrison
41 Amity Court
Pittsboro, NC 27312

Contribution statements will be provided at the end of the calendar year for tax purposes. Please contact us with any questions.

Thank you for supporting Fuel Up at Perry Harrison!