Pet Memorial Program For Veterinarians
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4PET M EMORIAL P ROGRAM F OR V ETERINARIANS
Please c omplete t his f orm b elow w ith c redit c ard i nfo a nd
email t o
i
o r p rint a nd f ax t o
877-933-0939. I f y ou a re p aying b y c heck, m ail t o W inn F eline
Foundation a t 6 37 Wyckoff Ave. Suite 336, W yckoff N J 0 7481.
Joining t he P et M emorial P rogram: Y our c lient w ill r eceive a n a cknowledgement o f y our d onation w ithin t en b usiness
days o f r eceipt o f y our d onation. Y ou a nd y our p ractice w ill b e l isted o n o ur w ebsite a s p articipants i n t he p rogram.
Please u se t he s econd p age s heet i f y ou a re r emembering m ore t han t hree c ats. W e a ppreciate y our s upport.
Your g ift i s t ax-‐deductible t o t he e xtent p ermitted b y t he I RS. W inn F eline F oundation i s a 5 01 c (3) n on p rofit
__________________________________________________
_ __________________________________________________
Doctor’s N ame
E mail ( a r eceipt w ill b e e mailed t o y ou)
__________________________________________________________________________________________
Hospital/Clinic/Practice
__________________________________________________________________________________________
Address
City S tate Z ip
Donation A mount P er C at: : £ $15 £ $20 £ $25 £ Other: _ _________________ D ate o f D onation: _ ____________
Total n umber o f c ats: _ _________________ T otal a mount d ue: $ _ __________________ £ C heck e nclosed
I w ould l ike t o c harge m y d onation £ Visa £ M astercard £ American E xpress £ Discover S ignature _ ______________________________________
Card # _ ________________________________________ N ame o n C ard: _ ________________________________________
CVV c ode _ _____________ E xp. D ate: _ _________
Remember t hese P ets:
__________________________________________________
_ __________________________________________________
Pet N ame
C lient’s N ame
__________________________________________________________________________________________
Address
City S tate Z ip
__________________________________________________
_ __________________________________________________
Pet N ame
C lient’s N ame
__________________________________________________________________________________________
Address
City S tate Z ip
__________________________________________________
_ __________________________________________________
Pet N ame
C lient’s N ame
__________________________________________________________________________________________
Address
City S tate
Z ip
August 2 014 W EBPV
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Parent category: Life