Habitat for Humanity of Monroe County

DONATION FORM 

Is this your first donation to Habitat for Humanity of Monroe County?

___ Yes      ___ No

Discover, Visa & MasterCard accepted.  Donation Amount:______________

Your Information:

Name:____________________________________________________________

Address:___________________________________________________________

City:______________________ State:____________ Zip:_____________

Phone Number:______________________________________________________

E-mail:_____________________________________________________________

Would you like to subscribe to our newsletter?

___ Yes      ___ No  If yes, in print ___ or via email listed above ___

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Habitat for Humanity of Monroe County will honor all donations made in memory or

in honor of individuals and groups with a gift announcement mailed to

your designee.  To designate your donation, please complete the following:

____Honorarium    ____Memorial

Name of Honoree: ____________________________

Please mail acknowledgement card to:

First Name:____________________________

Last Name:____________________________

Address:____________________________

City:____________________________

State:____________________________

Zip:____________________________

Phone Number:____________________________

E-mail:____________________________

Please allow 8-10 working days for your acknowledgement card to reach its

destination.

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If Donating by Credit Card, please enter the following information as it

appears on your credit card:

Name:____________________________

Credit Card Number:____________________________

Card Expiration:____________________________

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If paying by credit card you may fax this completed form to us at (812) 336-6022

OR

If paying by check or credit card, mail to the following address:

Habitat for Humanity of Monroe County

213 E. Kirkwood Avenue

Bloomington, IN 47408

Please do not hesitate to call us if you have any questions at (812) 331-4069.

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