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Bear-A-Thon Pledge Form

Please fill out form completely.  If you prefer to call in your information to donate, you can call 352-622-5600 in Ocala, or 352-375-7113 in Gainesville.

Name

Address

City, State, Zip

Daytime Phone Number

How many bears would you like to donate?

Form of Payment (Check/Credit)*

Credit Card Number

Expiration Date on Credit Card

CVC # **

Name as it appears on the card


If you prefer to send a check:
Make the check out to: Stop Children's Cancer

Mail the check to: 
K COUNTRY
3602 NE 20th Place
Ocala, FL 34470
 

 

 

    

 

 

 

 

 

 

*We accept MasterCard, Visa, American Express, Discover or a Check.

** The CVC number is the security number on the back of your credit card next to your signature.  It's
     a 3-digit number for MasterCard, Visa, and Discover.  It's a 4-digit number for American Express.

Your total will be $40 X      bears = $ 

Your donation is tax-deductible.  A receipt will be mailed to you.

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