Donor Mail Form
Please print and complete this form and mail it along with your donation to:
Culver Boys & Girls Club
Culver Community Elementary School
401 School Street
PO Box 44
Culver, IN 46511
Be sure to enclose your check or your credit card information.
Donor Information
Name:
Address:
City:
State:
Zip:
E-Mail Address:
Payment Information
Enclosed is my check for: $
Please charge my gift of: $
Payment Method American Express
Account No.
Exp. Date
Phone Number
Signature _____________________________________
Please make checks payable to Culver Boys & Girls Club. All gifts are tax-deductible to the extent allowable
by law. For more information, call 1-574-250-0103