BOL - Pay by Check | United Way of Central Kansas

Registation by Check

Name

Company

Email

Phone

Address

Address 2

City

State

Zip Code

How many $15 Boxes of Love are you purchasing?

Who are you purchasing for?

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Who are you purchasing for?

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Total $ 0

If purchasing more than 2, please list name and address in this section. If there is additional information, we need to be aware of when delivering, please also indicate in this section.