| Print this page from your browser First Name: __________________________________________ Last Name: __________________________________________ Address: __________________________________________ __________________________________________ City: __________________________________________ State: ___________________ Zip Code: _______________ Phone: ___________________ Fax: _______________ Email: __________________________________________ May we correspond with you via e-mail? Yes: ___ No: ___ -------------------------------------------------------------------------------- CPUSRV is a 501(c)(3) non-profit organization. Your contribution may be tax deductible (ask your tax preparer for details). Make your check payable to CPUSRV and mail this page to: CPUSRV PMB 360 1429 Avenue D Snohomish, WA 98290 Thank you! back to Give Now page |