SEDONA COMMUNITY CENTER

PRINTABLE ORDER FORM
Arizona Charitible Tax Credit Program

Print out this form and fill out the relevant information above
and mail the form with your check or credit card info to:

Sedona Community Center
PO Box 2894
Sedona, AZ 86339

Questions: Call the Center at 928-282-2834

I would like to contribute:
(Donate as much as you wish, but the maximum AZ state tax credit is $400 for a couple and $200 for an individual.)

$100 • $200 • $400 • $1000 • Other = amount

___ I WILL PAY BY CHECK

___ I WILL USE MY CREDIT CARD FOR PAYMENT:
(Master Card or Visa Only)

Name on the Card:
Card Number:
 (skip if paying by check)
Expiration Date
 month • year • 3 digit code on back
Billing Street Address
City
State
 • Zip
Phone
Social Security Number
 (for use on tax credit receipt)
E-mail
Comments/Questions
Signature
_________________________________________________________________
   
Print Name
 _________________________________________________________________
   

 

 
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