HELPING HANDS -- CARING HEARTS SPONSORSHIP FORM

Your Name:__________________________________________________________

Address:____________________________________________________________

City:____________________

State:____________

Zipcode:______________

Phone:________________________

E-Mail Address:______________________________________________________

Level of Sponsorship:

___ Bronze ($25 - $49)   ___Silver ($50 - $99)   ___Gold ($100 - $299)   ___Platinum ($300 +)

Names of the 3 pets you would like to sponsor, or the name of the specific pet for which

assistance has been requested.

1. ____________________

2. ____________________

3. ____________________

May we indicate your sponsorship on our website?  (Only your name is used on

the site in order to protect your privacy.)  ____ Yes     ____ No

Will you please tell us briefly why you want to become a sponsor?

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Method of Payment:  ___ PayPal   ___Personal Check   ___ Money Order

When paying by check, please be sure to enclose this completed form along with your payment. Make checks payable to:  AFBC

Mailing Address: Animal Friends of Barbour County

                           Rt. 2  Box 559

                           Philippi  WV  26416

We sincerely thank you for participating in our Helping Hands -- Caring Hearts Program.