Patriot Fund Donor Form

Recommended Levels
Operation Support: Family Defender: $26 (50¢/week) Frontline Patriot: $39 (75¢/week) Company Command: $52 ($1/week)	Mission Support: Battalion Command: $100 Regiment Command: $250 Division Command: $500 Corps Command: $1,000
Other Amount: $_______________

Please include your e-mail address so that we can credit your contribution to your subscriber account:

E-mail address: _________________________________

Pay by Check via U.S. mail

Mail this form and your check, payable to:

The Patriot Fund
PO Box 507
Chattanooga, TN 37401-0507

Pay by Credit Card (mail or fax)

Name: _________________________________

Street Address: _________________________________

City, State, Zip: _________________ _____ _________

Phone: (_____)___________________________

Credit Card Type: Visa MasterCard Discover AmEx

Credit Card #: _________________________________

Expiration: ____________ (Month / Year)

Cardholder Signature: _________________________________

Mail this form to the mailing address above OR Fax to 1-423-822-1826.

Thank you for supporting The Patriot.