Name Organization Name

Address city

State AK AL AR AZ CA CO CT DC(District of Columbia) DE FL GA GU(guam) Hi IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI(Virgin Islands) VT WA WI WV WY

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E-mail

I support the seedling surcharge of $1.00 per thousand for containerized seedlings and $0.50 per thousand for bareroot seedlings to support The Longleaf Alliance with a maximum amount of $5,000.00 for my organization.

The surcharge my organization expects to collect in the Year 2003 2004 2005 2006 2007 2008 2009 2010 is approximately (Note: this is not a commitment to the collect this amount but will be helpful to us in budget planning).

The best payment schedule for my organization is: In Full Incremental In Advance (For budget purposes we prefer receiving surcharge payments by no later than January 1 of each year).

I want a hyperlink my organization's web page from The Longleaf Alliance's web page nursery list. I understand that my organization will be invoiced a fee of $50.00/year for this service (Note: fees are subject to change at the discretion of The Longleaf Alliance). The URL for my organization's website is .

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