Balloon Donation Form printable pdf download

Balloon Donation Form

COSTCO WHOLESALE

CHILDREN’S MIRACLE NETWORK

CAMPAIGN

BALLOON DONATION FORM

COMPANY NAME: _________________________________________________________

COMPANY ADDRESS: _________________________________

_________________________________

DIRECT CONTACT: Name: ________________________________

Phone Number: _________________________

Please indicate your Balloon/ Donation choice:

(

) Medium $100- $249

(

) Large $250- $499

(

) XL Large $500-$1,000

9.5” Wide X 14” Long

18” Wide X 27” Long

Life-sized

Please list any information you would like to appear on your balloon: (i.e.: Company name, phone

number, address or location, website, special offers, etc.)____________________________

_______________________________________________________________________

*** Your balloon will be displayed for the duration of the campaign which will run the

entire month of May. Each donation will include a corporate match which will be paid

directly to Children’s Hospital of Wisconsin. ***

Please fax this form to: (262) 204-1054 and/or mail with payment to:

Costco Wholesale #628

Attn: Children’s Miracle Network Campaign

950 N. Port Washington Rd.

Grafton, WI 53024

Cash or check payments accepted only. Please make checks payable to Costco Wholesale.

Any questions, please contact the Grafton Costco’s Marketing Department at (262) 204-1095.

THANK YOU FOR SUPPORTING YOUR LOCAL CHILDREN’S HOSPITAL!

Balloon Donation Form