The Tejano Statue-Capitol Inc.
Contribution Form

The preferred method of payment is by Check or Money Order.
Verification of your "Tax Deductable Contribution" will be sent upon receipt of payment.
(Please Print or Type)

Respondent's Name:

Organization:
Primary Mailing Address:

City: State: Zip:

Phone:

Fax:

Email:

Amount of Contribution:

Payment Type: (Circle One)

Check Money Order

(Checks and Money Orders should be made payable to Tejano Statue-Capitol, Inc.)

PRINT AND COMPLETE THIS FORM AND MAIL IT WITH YOUR PAYMENT TO:

Burton McCumber & Cortez LLP, CPA
c/o Richard Cortez CPA
P.O. Box 2948
McAllen, Texas 78502-2948

THANK YOU FOR YOUR SUPPORT!



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