DONATION FORM

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To mail Leaven donations, send this form with payment to:

LEAVEN
P.O. Box 13245
Denver, CO  80201-4645

_____ $25.00                _____ $50.00                 _____$100.00                Other _________
Name  ______________________________________________________________________
Address _____________________________________________________________________
City, State, Zip ________________________________________________________________

Phone# ______________________________________

E-Mail ______________________________________________________________________

How did you learn about Leaven? _________________________________________________

_____________________________________________________________________________

Donation Category

_____ Web Site Development        _____ Writers                      _____ Production        

_____ Marketing                            _____ Administration          _____ Area of Most Need

Thank You!


FOR OFFICE USE ONLY

           REC'D                                CK#                                    AMT$                                  DB UPDATE