Habitat for Humanity of Lafayette

DONATION FORM

Checks, Discover, Visa & 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 Lafayette's quarterly Newsletter?

___ Yes      ___ No

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Habitat for Humanity of Lafayette 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 acknowledgment card to:

First Name:____________________________

Last Name:____________________________

Address:____________________________

City:____________________________

State:____________________________

Zip:____________________________

Phone Number:____________________________

E-mail:____________________________

Please allow 8-10 working days for your acknowledgment 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: (765) 742-5870

OR

If paying by check or credit card, mail to:

Habitat for Humanity of Lafayette

420 South 1st. Street 

Lafayette, IN 47905

Please do not hesitate to call us if you have any questions:  (765) 423-4590

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