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Annual Fund Contribution Form
Please fill out if you are SPAM BOT

 Contribution Form

* = Required

Friend up to $99     Sponsor $100-249     Leader $250-$499
Ambassador $500-$999     Berkshire Circle $1,000 or more



Note:  If you wish to contribute by check, please print this form and mail it to:

 BCC Foundation. Attn. Ann Phillips
1350 West St., Pittsfield, MA   01201

 

Contact Information
Name (s):*
Address:*
 
City:* * *
E-mail:*
Home Phone:* Work Phone:
Fax Number:
 Occupation/Employer:  
My check, payable to the BCC Foundation Annual Fund, is enclosed for: Full payment
Partial payment
Bill me quarterly
Please bill to my credit card.
Credit Card Information
Cardholder Name:* (As it apppears on your card)
Card Type:*
Card Number:*
CVV:*   (3-digit number on back of card)
Exp. Month:* Exp. Year:*
     
Billing Information Check if same as above.
Address:*
Address:*
City:* * *
Phone Number:*
     
To make a gift of appreciated securities, please call us at 413-236-2188 for instructions.
     
My/my spouse's employer has a matching gift program. I will send a matching gift form by postal mail.
     
Please tell us how you would like your name to be listed:
I prefer my donation to be anonymous.
     

Please check all that apply:
  Alumnus