"Printable" Form

Please use the following form to make a donation to the Political Victory Fund.

Please provide the following contact information:

First name:	______________________	Principal Occupation: ____________________________ ( - Job title/employer will suffice. If you wish to not disclose this private information, please write, "decline to state". Please do not leave this blank.) Amount of Monthly Pledge: $__________ An Extra Amount To Help Now: $__________ A One-time, don't-bother-me-again donation* $__________ Total (make check out to: "GRNC-PVF") $__________
Last name:	______________________
Street address:	______________________
Address (cont.):	______________________
City:	______________________
State/Province:	______________________
Zip/Postal code:	______________________
County:	______________________
Work Phone:	______________________
Home Phone:	______________________
FAX:	______________________
E-mail:	______________________
URL:	______________________

(* -- We will bother you again anyway. After all, we need the money to cause some serious "bother" to those who richly deserve it. Look at the bright side -- at least we do not fill your mailbox with special beg letters like another gun-related organization.)
Please send this completed coupon (make sure to fill out reverse side!) with your check to:
GRNC-PVF
c/o Tom Rhyne, Treasurer
P.O. Box 10684
Raleigh, NC 27604

It saves the GRNC-PVF money if monthly payments are sent in without our prompting. Save the other coupons for subsequent months. Keep them with your checkbook or your stack of monthly bills. (Better if it is with the checkbook). Please call 919-664-8565 for more information on the PVF.
Thank you for your support!