Buffalo Soldier Monument
Tucson Buffalo Soldier Monument, P.O. Box 27659, Tucson, AZ. 85726
Contribution Individual: Group: Organization
Date: mmddyy: Group/Organization:
First Name Last Name
Address City StateZip
· Fill out order
form online, then print a copy. Mail form & Check to our address above; Copy and paste completed form into MS Word.
Select Submit button and email the Word copy to us. *
· Please make checks payable to
“Tucson Buffalo Soldier Monument”.
Your Individual or Group Contribution
Level of Contributions
Private $25.00 Corporal $40.00 Sergeant $50.00
Sergeant major $100.00 Lieutenant $125.00
Captain $250.00Major $500.00 Lieutenant Colonel $650.00
Colonel $1250.00 General $2500.00
Contribution Amount: All contributions are tax deductible minus
any benefits you might receive.
You are paying by, Check Money Order OtherNo cash please
Total Amount Enclosed