E-Vam Buddhist Institute
                               Pledge/Contribution Form
						 

Your name: ............................................................................... Date: ....................

Principle Address: .....................................................................................................

................................................................. Zip code:................................................

Principle Contact Phone No .......................................................................................

E-mail address: ........................................................................................................



I am interested in supporting the activities of the E-Vam Buddhist Institute, New York

with the following pledge of $ ..................


Mode of payment:

____enclosed is my check/money order

Please make your checks payable to: E-Vam Buddhist Institute


____credit card ____debit card (visa or master card only)

Credit card number: .................................................................... Exp.date ___/___

Name on account: ...................................................................................................

Billing address: ........................................................................................................

.................................................................. Zip code:...............................................

Signature ................................................................................................................



Thank you for your support of E-Vam Buddhist Institute.


Please send your contribution with the completed form to:

E-Vam Buddhist Institute
Contributions
171 Water Street
Chatham, NY 12037