Habitat for Humanity of St. Joseph County
DONATION FORM

Checks, Visa, and MasterCard accepted.

Donation Amount:______________

Your Information:

Name:__________________________________

Address:____________________________

____________________________

City:____________________________

State:____________________________

Zip:____________________________

Phone Number:____________________________

E-mail:____________________________

Would you like to subscribe to Habitat for Humanity of St. Joseph County's quarterly Newsletter?

___ Yes      ___ No

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Habitat for Humanity of St. Joseph 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: 574.289.1954
OR if paying by check or credit card, mail to:

Habitat for Humanity of St. Joseph County
402 E. South Street
South Bend, IN  46601-2416

Please do not hesitate to call us if you have any questions:  574.288.6967

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