Southeast Spouse Abuse Program A Family Violence Intervention And
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Southeast Spouse Abuse Program A Family Violence Intervention and Prevention Agency Donor Information (please print or type) Name Billing address City State ZIP Code Telephone (home) Telephone (business) Fax E-Mail Ad Information
I (we) would like to purchase an Ad: ____ Full Page $100 ____ ¾ Page $75 ____ ½ Page $50 ____ Business Card $25. Enclosed Method of Payment: ____ Check ____ Money Order Signature(s) Date Please make checks payable to: Southeast Spouse Abuse Program P.O. Box 1946 Hammond, LA 70404
I (we) would like to purchase an Ad: ____ Full Page $100 ____ ¾ Page $75 ____ ½ Page $50 ____ Business Card $25. Enclosed Method of Payment: ____ Check ____ Money Order Signature(s) Date Please make checks payable to: Southeast Spouse Abuse Program P.O. Box 1946 Hammond, LA 70404
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