Contribution Form

Unfortunately, we are not yet equipped to handle online credit card transactions at this time. However, you may fill out the form below, print it, and mail it to us. This form functions like any other Internet form, in that you may type your information directly into it; but because there is no way to submit it, rest assured that no one can see the information you type here. Please print and send your completed form to:

WHIL Radio Reading Service
P.O. Box 8509
Mobile, AL 36689-0509

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All fields are required.

Please accept my gift of: $
Please charge to: Please select one Visa Mastercard American Express Discover
Card number: Expiration date (MM-YY):

Name as it appears on card:
Mailing Address (Street or P.O. Box):
City: State: Zip:

E-Mail address:

Home Phone:
Work Phone:

Signature:

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This page last modified July 11, 2000.