NID LWML Financial Secretary                                              Date

MAKE CHECKS PAYABLE TO:  NID LWML

To insure proper credit to your account, please include this form with ALL remittances.

Fill out completely, print 2 copies (one to keep for your records), and mail to the NIDLWML Financial Secretary.

Name of congregation:

Location in (City or Town):                                                                 Pastor:

Circuit or Zone number:

Donation for Mites: $                  Special Donation type name and amount:

Donation for Quarterlies: $

Donation for memorial:  $

Remitted by name, mailing address, phone or e-mail:             

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