Tails of the Tundra Siberian Husky Rescue Inc: Donation Form

PO Box 612
Colmar, PA 18915
www.siberescue.com
(215) 412-0270

Virtual Harness Form: Please print out this form, fill it out and mail it along with your donation to TOTTSHR, Inc. PO Box 612 Colmar, PA 18915

Your Information:
Name:	________________________________________________
Address:	________________________________________________
City, State, Zip:	________________________________________________
Phone Number:	________________________________________________
Email Address:	________________________________________________

Virtual Harness Information:
I would like to purchase a virtual harness	in Memory...	in Honor...
Name:	________________________________________________
City, State	________________________________________________
Would you like the total dollars raised on behalf of this harness to be visible to others?	Yes____ No____
Comments:	________________________________________________
	________________________________________________
	________________________________________________
	________________________________________________
	________________________________________________
	________________________________________________
	________________________________________________ ________________________________________________ ________________________________________________
Would you like us to notify anyone of this harness creation?	Email ___________________________________ Regular Mail _______________________________

Donation Information:
Amount of Donation:	________________________________________________