The Delapaz Education and Welfare Fund Information Form
Please provide us contact information about yourself and the items you
 want to contribute. Print, Complete, & Mail with shipment or money to:
DEAWF, 845 E 5th, Marysville, OH 43040-9484 USA
To get a receipt from DEAWF for your donation, complete this section:
Name:
Address:
City State Zip:
Email:
Telephone:
If Check is enclosed, complete this section:
Check Amount:
If Credit Card is used, complete this section: (MC, V, AmX)
Credit Card Number:
Expiration Date:
Name on Card:
Billing Address:
City State Zip:

I am at least 18 years old and the authorized user of this card
Signature: Date:

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