Donation Form Bassett Historical Center

Bassett Historical Center Donation Form View a printable brochure

Name

Address City State Zip

Phone E-Mail

Enclosed is my/our gift to the Bassett Historical Center Building Fund:

Payment in full $ Or

Payment of $ Annually Or

Semi-annually Or in Monthly Payments of $ for years

Signed Date

For a $1000 memorial or honorarium of a loved one, your parent/parents, spouse, children, or whatever designation you choose, please indicate what you would like on a plaque that will be placed in a prominent position. The maximum number of characters is 35, including spaces and punctuation.

In Honor of (name/s)

Given by

In Memory of (name/s)

Given by

Given by (your name)

Please notify recipient/recipient's family

Please notify the recipient that an anonymous donor has honored

Please complete and mail to:

Bassett Historical Center Building Fund
3964 Fairystone Park Highway, Bassett, VA 24055

Bassett Historical Center . 3964 Fairystone Park Highway . Bassett, Virginia 24055 . (276)629-9191
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