Chase Stone Barn Donation/Pledge Form

A campaign for the restoration and preservation of the historic Chase Stone Barn

Those who give $1,000 or more will become a cornerstone donor and receive a stone with their name or company name engraved.  All stones will be permanently displayed at the park.  Other naming opportunities are also available.  Please contact Kris at (920) 822-5447 for more information.

q      Enclosed is my monetary donation for $____________________. 

q      I pledge a total of $ ____________________  ( All pledges must be paid in full by June 30, 2012 )

       $ _________________ in 2011, and $ _______________ in 2012.

REQUIRED INFORMATION: 

Print Name:  ____________________________________________________________________ 

Address:  ______________________________________________________________________ 

Phone ( _______ ) _______ - ____________  E-mail (optional):  __________________________

Payment Options:  The Town of Chase Municipality is not a 501(c)3, but a governmental entity.  All donations are tax deductible.  Please choose Option 1 for your payment if possible.  If your company requires their donation to be made to a 501(c)(3) non-profit organization, then please choose Option 2. 

Option 1:    Make check payable to Town of Chase and memo Stone Barn Park Fund
Mail to Kristin Kolkowski, 9435 Anne-Jo Ln, Pulaski, WI  54162

Option 2:    Make check payable to Pulaski Area Historical Society and memo Stone Barn Park Fund. Mail to Pulaski Area Historical Society, 129 West Pulaski Street, PO Box 944, Pulaski, WI 54162

Signature (required): ________________________________________ Date: _____________________