Donation/pledge Form - Habitat For Humanity-La Crosse Area
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1DONATION/PLEDGE FORM
Please return this completed form to
PO Box 2123, La Crosse, WI 54602
or fax to 888-823-9830
DONOR INFORMATION
Name ________________________________________ Company Name ________________________________
Address _____________________________ City ______________________ State _______ Zip ____________
Phone Number _____________________________ Email Address _____________________________________
No, thank you!
Would you like to receive our quarterly e-Newsletter?
Yes
Check how you are affiliated with Habitat for Humanity-La Crosse?
Past Donor
Volunteer
Board Member
New Donor
Staff Member
DONATION/PLEDGE INFORMATION
Enclosed is my gift of $_______________________ payable to Habitat for Humanity La Crosse Area
I/we pledge a total of $_______________. Enclosed is a payment of $____________ with a remaining balance of $___________.
I wish to have this donation spread out over ____
1 year
2 years
3 years
4 years
5 years.
I will be paying
Monthly
Quarterly
Semi-annually
Annually
One time gift of $________________________
Monthly Donation of $____________________ for
1 year
2 years
3 years
4 years
5 years.
Type of Card:
Visa
Mastercard
Discover
Name on Card ____________________________________ Account Number ____________________________________
Expiration Date ___________________
Three Digit Security Code __________________
I authorize Habitat for Humanity La Crosse Area to debit my credit card account.
Signature ________________________________________________
Date _______________________
DONOR RECGONITION
I/we wish to be listed among the campaign of donors as follows ______________________________________________________
I/we wish for our donation to remain anonymous
MEMORIAL/TRIBUTE INFORMATION
Make your gift a memorial or tribute
In Memory of _________________________________________
In Honor of _________________________________________
MATCHING
I/we will seek a matching gift from my/our company.
Company Name _______________________________________________
Thank you for supporting Habitat for Humanity-La Crosse Area. Your gift is greatly appreciated and allows us to continue to bring people
together to build homes, communities, and hope. You can also donate online at Habitat for Humanity La Crosse
Area is a 501c3 charitable non‐profit. Tax ID 39‐1706999. All donations are deductible to the fullest extent allowed by the IRS.
PO Box 2123 * La Crosse, WI 54602 * 608-785-2383 * *
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