Habitat for Humanity of Valencia County

DONATION FORM

Is this your first donation to Habitat for Humanity of Valencia 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 Habitat of Valencia County's quarterly Newsletter?

___ Yes      ___ No

~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~

Habitat for Humanity of Valencia 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.

~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~

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

appears on your credit card:

Name:____________________________

Credit Card Number:____________________________

Card Expiration:____________________________

~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~+~

If paying by credit card you may fax this completed form to: (505) 565-0430

OR

If paying by check or credit card, mail to:

Habitat for Humanity of Valencia County

P.O. Box 3184

Los Lunas, NM 870231

Please do not hesitate to call us if you have any questions:  (505) 839-3851

Close Print Window