The Data Express Information System

                       Adopt-A-Door Donation Form

Your Name________________________________________________________________

Your Home Phone Number__(      )-     -

Your Password on Data Express____________________________________________

Name of Door to sponsor__________________________________________________

Second choice if any_____________________________________________________

Amount of donation_______________________________________________________

Please do not send cash.  Make checks or money orders payable in U.S. Funds

Send to:
        Charles Morgan
        S-5943 Rosewood Terr.
        Lake View, NY 14085

   Thank you for making The Data Express Information System a better board.