______ Small Businesses (1 – 5 Employees)  

  $100

______ Medium Sized Businesses (6 – 10 Employees)  

 $250

______ Large Businesses (11 or more Employees)

 $500

______ Banks with less than $100 Million in assets  

$250

______ Banks with assets greater than $101 Million  

$1,000

______ Individuals  

$50

______ Utilities  

$1000

______ Parishes Villages  

$250

______ City of Bastrop  

$10,000

______ Morehouse Parish Police Jury  

$5,000

______ Morehouse Parish School Board  

$1,000

______ International Paper Company  

$1,000

Company Name:

Address:

City, State, Zip:

Contact Person Name:

Telephone Number:

Fax Number:

Email Address:

Web Site Address: