To donate to the Central Orchard Mesa Fire Department please print this form, fill it out and
return the top portion with your donation to:

Central Orchard Mesa Volunteer Fire Department
3253 B 1/2 Road
Grand Junction, Colorado, 81503
Attn: Chief Dave Gitchell

Thank you for your generosity and support,
Sincerely,
The Volunteers of the Central Orchard Mesa Volunteer Fire Department
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                                    Enclosed please find my donation to the Central Orchard Mesa Fire Department                 
                  
                                   for the amount of $___________________         Date:______________

                                                From:__________________________________

                                               Address: ________________________________

                                                            ________________________________

                                  Please mail your donations to: Central Orchard Mesa Volunteer Fire Department
                                                           3253 B 1/2 Rd, Grand Junction, Colorado, 81503
                                                                             Attn: Chief Dave Gitchell

                                                                       Thank you
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                                                      Please keep this copy for your records

                                    Donation amount $ _________________         Date: _________________

                                    Check number # ___________________





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