Elbert Guillory's America

Mail-In Donation Form
To make a donation by mail, please print this form out and clearly complete the information below. Send this form with a check or money order payable to Elbert Guillory's America, PO Box 1492, Merrifield, VA 22116-9404

Donor Information

First name:____________________

Last name:____________________

City:_______________ State:_____ Zip:________ Country:_______


Primary Phone #:________________

Gift Information

Yes, I would like to make a one-time gift of $_______

Yes, I would like to make a monthly gift to Elbert Guillory's America. Please charge $_______ to my credit card every month.

Information Required by FEC



Payment Type (select one)

Check/Money Order (one time gifts only) Visa Master Card
American Express Discover

Credit Card Number:____________________
Expiration Date(mm/yy):______


Contributions to Elbert Guillory's America are not tax deductible. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year. An individual may contribute up to $5,000 per calendar year.

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