Matching Grant Fund-raising Form
It's easy!

Just print out this page, fill in the information and mail it or fax it to:

• Make checks payable to FourWinds Academy .
• Mail to FourWinds Academy , 4157 Crossgate Drive , Cincinnati , OH 45236
• Fax to (513) 891-1648

Please write very clearly

Name:__________________________________________________________

Address:________________________________________________________

City_________________________ State:_______________ Zip:___________

Phone Numbers: ____________________ Cell:_________________________

Email: __________________________________________________________

Donation: $___________ *Payment Plan: Yes No

If paying by credit card (do not send via email):

Circle card used : Mastercard   Visa   American Express   Discover

Name on Credit Card: _____________________________________________

Billing Address of Card:____________________________________________

(If different from home address)

________________________________________________________________

 

Card Number: _____________/___________/_____________/_____________

Security Code (on back):_____________ Expiration:______/_______/_______

 

*Payment Plan Explained: For donations which exceed $150, you can pay in 3 monthly installments.

 

| Home | About Us | Classes&Courses | Register| Links | Contact Us| Directions |