Five Star
    Community Center

 A Proud Tradition Making
     South St. Louis
 A Great Place to Call Home!

 Your tax deductible donation makes the
 Community Center possible. 

 Please help by Donating - using this form
 or mailing your check to:

 Five Star Senior Center
 2832 Arsenal
 St. Louis, MO 63118

  Mastercard/Visa

  Donation Amount $  
                                         (example: 25.00)

  Add:    "Grandma's Favorite Recipes"  Cookbook
   please check the box $15.00 

 Account No.
                       (no spaces or dashes)

 Expiration Date: 1 2 3 4 5 6 7 8 9 10 11 12   2007 2008 2009 2010 2011 2012 2013 2014 2015

 Name:
                  (as it appears on your credit card.)

 Address:
                       (billing address of credit card)

 City:        State:  MO IL       

 Zip: 

 E-mail:

 Phone: (3146641008 no spaces)

 Signature: 

 I declare that I am 18 years of age and authorized to make this
 TAX DEDUCTIBLE donation to Five Star Senior Center using
 the above credit card.