I want to help underwrite the cost of The Library Project.

$3600.00 - CCTV

$600.00 - ZoomText Software

I would like to make a tax-deductible contribution in the amount of $

If you would like to pay by check, please do so at :

Foundation For Sight & Sound
P.O. Box 1245
Smithtown NY 11787

For more information
please contact The Foundation for Sight and Sound

(none) Dr. Dr. & Mrs. Dr. & Mr. Mr. Mrs. Mr. & Mrs. Mr. & Ms. Miss Ms. Title *First Name Middle Name *Last Name

*Address Line 1

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*E-mail address *Phone Number Fax Number (if available)

Comments

Paying by check

Please bill this amount: Only This Once Monthly Quarterly Yearly ... Indefinitely 1 time 2 times 3 timesvalue=4>4 times 5 times 6 times 12 times in addition to this first payment.

Name on Card: Credit Card Number:

Expiration Date: Select a Month January February March April May June July August September October November December Select a Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021