Mail-In Donation Form

 

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Yes, I/we want to support the work of Citizens for Adequate Housing, Inc.

  __$1,000       __$500       __$250      __$100       __$50      __$25      ___$______         

 

Name ________________________________________ Address_____________________________

City _________________________________________ State_______________ Zip _____________

Telephone __________________________________ Email _______________________________

Please designate my gift to the following:            

Mail-In Donation Form

 

_       General            Inn Between Shelter            Inn Transition Shelter             Communities Land Trust

 

 

Please charge my Visa or Mastercard  (please circle one)

 

Account # ____________________________________________ Expiration Date: _______________

  

Signature: _________________________________________________________________________                 

Enclosed is my donation of $_____________ to Citizens for Adequate Housing, Inc.

 

If this gift is a memorial or honorary gift, please provide the following information.  Your gift will be acknowledged to the person designated (the amount of your gift is confidential).

 

 

    In memory of                                                                      In honor of, Occasion: _________________

                                                                                          (birthday, anniversary, wedding, other)

 

Name of Honoree:                        __________________________________________________________

Card mailed to:                             __________________________________________________________

Address:                                       __________________________________________________________

                                                    __________________________________________________________

                 

  Please make checks payable to Citizens for Adequate Housing, Inc.

                                                                All contributions are tax deductible to the extent allowed by law. For                                                                        additional information, please call (978) 531-9775 x17

                                

Please mail completed form to:                                 Citizens for Adequate Housing, Inc.

                                                                                  40 Washington Street

                                                                                  Peabody, MA 01960