Name

Organization

Address

City, State, Zip

Daytime Phone Number

E-Mail Address (required)

I would like to donate the following: Select one ... $750 - buys a laptop computer, software, and set-up for a needy nonprofit $300 - buys a computer for a needy nonprofit $75 - buys one hour of tech support for a needy nonprofit $28 - buys Microsoft Office and XP Professional for a needy nonprofit Other: please specify ...
Other amount and purpose:
   

Payment option:

• If you are paying by check: Mail this completed form with your check to Project Connect, 474 Grant St, Akron OH  44311.
• If you are paying by MasterCard or Visa: Print this form, write down your credit card information, and fax this completed form 330-315-0399 or mail it to the address above.

Check enclosed
Charge my credit card:  __ Visa         __ Mastercard
       Will appear as “INFO LINE” on your statement

Number _____________________________ Exp _________

Signature _______________________Security Code______

Do you want us to direct your gift to a specific nonprofit?

Do you want to add a special note to the nonprofit?