SUSTAINABLE ENERGY RESOURCE GROUP DONATION FORM

Name _________________________________________ Phone__________________________ Address________________________________________________________________________
Town/State/Zip__________________________________________________________________
Email (Please Include) __________________________________________________

Enclosed is my tax-deductible contribution to SERG:
$1,000* _____ $500* _____$250* _____ $100* _____ $50* _____ Other________

* Contributions of $50 or more qualify you as a member of the SERG Energy Alliance to receive discounts on energy efficiency and renewable products and services. A complete list of participating Energy Alliance dealers and their discount offers is available and is updated quarterly at NEW SERG Energy Alliance.

______ Please keep my contribution anonymous.

______ Please save time and resources with an email acknowledgement.

______ Please tell me how I can do more by contributing my time.

Energy or Project Comments, Suggestions or Interests __________________ _______________________________________________________________________

100% of every dollar you give funds SERG programs. Thank you very much for your generous tax-deductible contribution.

Please print and mail this completed donation form with check can be made to "SERG" to
SERG, 432 Ulman Road, Thetford Center, VT 05075.

Questions or additional info, contact: SERG@valley.net, 802-785-4126 or www.SERG-info.org