Donation Form

Black Hills Community Theatre

PO Box 4007

Rapid City, SD 57709-4007

605-394-1787

Donor Information (please print or type)

Name

Address

City

State

ZIP Code

Telephone (Home/Work/Cell)

Fax

E-Mail

Donation Information

We are donating: Description:

Gift Certificate

Cash/Check

New or Used Items

Tax Deductible Services

To benefit: ___Costume Shop ___Scene/Prop Shop ___Administrative Dept ___Children’s Programs

Credit Card

Credit Card Type:

Credit Card Number:

Expiration Date:

Authorized Signature:

Check:

Check Number

Acknowledgement Information

Please use the following name(s) in all acknowledgements:

___I/ (we) wish to have our gift remain anonymous.

Signature(s)

Date

Please make checks payable to:

Black Hills Community Theatre

PO Box 4007

Rapid City, SD 57709-4007