| New England Electric Railway Historical Society SEASHORE TROLLEY MUSEUM Atlantic Shore Line locomotive 100 Donation |
Thank you for your support of Atlantic Shore Line locomotive 100. Your donation will be put towards the restoration and development of educational material for community exhibits and school curriculums.
Name - Please Print clearly: ______________________________________________________
Membership Number (if applicable): ___________________
Mailing Address: _____________________________________ Telephone: _________________
City, State, Zip: _________________________________________________________________
Enclosed is my ASL-100 donation in the amount of $__________
| I prefer to pay with: | [__] Check | [__] Charge Card, Type (Please circle): AMEX - MC - VISA - DISC |
| [__] Money Order | ||
Card/Check #: _____________________________ Exp. Date: ___/______ Verification #: _________
- The verification number is a 3 or 4 digit number usually found on the back towards the right side of the signature box.
Signature: _________________________________________
Make checks payable to the "New England Electric Railway Historical Society"
Donations are tax deductable under Section 501(C)(3) of the Internal Revenue Code.
| Please mail this completed application form to: | Seashore Trolley Museum P.O. Box A Kennebunkport, ME 04046-1690 |
| Thank you for your generous support of the ASL-100 Project. |