Rural Water Partnership Fund
Contribution Form

Rural Water Partnership Fund

2915 S. 13th Street, Duncan, OK 73533

 

Name

Address

City: State:   Zip:

e-mail:   Telephone:

Contribution Amount $
 

To contribute by credit card, call 1-800-332-8715 or FAX this form to 580-255-4476 or mail to the above address.
 

VISA  MasterCard  American Express Discover Card

Card #

Expiration Date:

Signature: