Survivor Fund Corporate Donation Form

To donate to the International Towing and Recovery Hall of Fame and Museum
Survivor Fund, please fill out and submit this form. Or, print and fill out this form, and
send it with your payment enclosed to:
ITRHFM Survivor Fund
3315 Broad Street
Chattanooga, TN 37408
or fax to 423-267-0867


Name:
Company:
Address:
City:	State:	Zip:	Country:
Phone:	Fax:
E-mail Address:

Type of Donation:

Personal Donation
Corporate Donation
Gift in memory of someone Name
Gift in honor of someone Name

Please send an acknowledgement card to

Name:
Address:
City:
State:
Zip:
Country:

One Time Gifts

Amount:	$25	$50	$100	$250	$500
	$1000
Other Amount:

Credit Card Details

Card:
Expiration Date:
Name on Card:
Security Code:
Billing Address:
City:
State:
Zip:
Country:
Authorized Signature:


Note: Credit card information is required to ensure your credit card is properly processed. This information is used solely for the purpose of processing of the credit card for the requested transaction(s). Contributions to the International Towing and Recovery Hall of Fame and Museum Survivor Fund, a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code, are deductible for computing income and estate taxes.For more information, call the museum at 423-267-3132.