Thank you for making a donation to THE MANZO FAMILY. Please fill in your personal information below so we may send you a t-shirt that shows your dedication and support to Nick’s rehabilitation and his family.

Please make checks or money orders payable to: Chris or Kenny Manzo

Mail to:             c/o Rapid Road & Repair Services, Inc.

669 Route 25A

Rocky Point, NY 11778

Date:____________________________

Name:__________________________________________________________________

Address:________________________________________________________________

________________________________________________________________________

Daytime Phone #:_________________________________________________________

Donation Amount:_________________ Check #:_________________

Email Address:___________________________________________________________

If you would like to be on our email mailing list

For more information you can visit us on the web:

www.thenickmanzofoundation.org

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*THANK YOU FOR YOUR DONATION*

Please keep this portion for your records

[not a tax deductible donation]

   A Donation in the amount of $____________ ck #________was made to

THE MANZO FAMILY

                        on _____/_____/ 2008 made payable to: Chris or Kenny Manzo

                         Mailed to:        c/o Rapid Road & Repair Services, Inc.

                                                669 Route 25A

                                                Rocky Point, NY 11778