Make a Donation!
Wisconsin Polka Boosters
501 - 3C Non Profit Organization
W153  N10035 Neptune Dr.
Germantown, WI. 53022-5237

DONATION TAX EXEMPT FORM
(CORPORATION OR PERSONAL)

Please Print

NAME:___________________________________________________________________

ADDRESS:_________________________________________________________________

CITY:____________________STATE:____________________ZIP:_____________________

PHONE:_________________________

DONATION AMOUNT: $____________

% of donation to Wisconsin Polka Boosters Expenses:______________________________
    To pay for polka bands at the annual polka fest.

% of donation to Wisconsin Polka Boosters Scholarship fund:________________________

Wisconsin Polka Boosters Federal Tax I.D.    #39 - 1149593

* Note: If a corporation, you can send an advertising board 20" X 24" for a display at our annual polka festival for the year of your donation.

Keep a copy of your check and this form for your tax records.

PLEASE MAKE YOUR CHECK PAYABLE TO:  WISCONSIN POLKA BOOSTERS
MAIL THIS FORM AND YOUR CHECK TO:       JERRY CAREY
                                                                                  N68  W33785 HWY CW
                                                                                  OCONOMOWOC, WI. 53066

ANY QUESTIONS CALL:  JERRY CAREY                 (920) 474-4545
                                             VERN BLANKENBURG  (262) 255-2191
                                             DON BOECK                   (414) 258-2030

Received by Polka Booster:_____________________Date:___________Treasurer:_____________________