The Patriot Post Donor Form

Mail this form and your credit card information or check, payable to:

The Patriot Fund
PO Box 507
Chattanooga, TN 37401-0507

Recommended Levels
Operation Support: $26 (50¢/week) $39 (75¢/week) $52 ($1/week) $78 ($1.50/week) $104 ($2/week)	Mission Support: Battalion Command: $250 Regiment Command: $500 Division Command: $1,000 Day of Liberty Mission Sponsor: $1,776 Day of Liberty Operation Sponsor: $2,020
Other Amount: $_______________

Please include your e-mail address so that we can credit your contribution to your subscriber account:

E-mail address: _________________________________

Pay by Credit Card (mail or fax)

Name: _________________________________

Billing Street Address (required): _________________________________

City, State, Zip (required): _________________ _____ _________

Phone: (_____)___________________________

Credit Card Type:    Visa    MasterCard    Discover    AmEx

Credit Card #: _________________________________

Expiration: ____________ (Month / Year)

CVV/CVC: ____________ (Three Digits (Visa, MasterCard, Discover) or Four Digits (American Express))

Cardholder Signature: _________________________________

Mail this form to the mailing address above OR Fax to 1-423-822-1826.

Thank you for supporting The Patriot Post.