OldChesterPa.com: Individual Sponsorship Form

Thank you for your willingness to help to sponsor OldChesterPa.com!

Please note that this is not a secure server. You may prefer to complete the form, print it out and then submit by fax or regular mail.

Fax to: 336.349.5297
Mail checks payable to:
OldChesterPA Heritage Foundation
351 Pin Tail Drive
Reidsville, NC 27320-9186


What kind of sponsorship would you like?

In Memory Of    In Honor Of
Name exactly as you would like it to be listed:

Please choose level of Sponsorship

Monthly ($10 per month)  Quarterly ($25 per quarter)   Annual ($100 per year)

I will mail or email picture(s)

Mail     Attach to Email

Payment method, please choose one

Check enclosed (made payable to OldChesterPA Heritage Foundation)

Please charge my Visa or MasterCard Account #

Expiration date:

Signature (for fax and mail orders): ______________________________________

I don't want to put my credit card number online - please call me at the number above for my credit card information.
The best time to call is:

Enter any additional comments in the space provided below:

Copyright 2002 Graphic Details Publications. All rights reserved.
Revised: October 18, 2005.