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Community Action Center
350 SE Fairmont Rd
Pullman WA 99163

Please find my donation of $________________

I would like my donation to be used in support of _____________.

Please charge my Visa/Mastercard $___________

Card # _________________________________

Exp Date _______________________________

The following is the manner in which my/our name is authorized to appear on any official/public recognition:

Name: ______________________________________

Signature: ____________________ Date __________

Mailing Address: ______________________________

______________________________

Phone:_________________ Email: _______________