Habitat for Humanity of Bergen County

DONATION FORM


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


___ Yes      ___ No


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Habitat for Humanity of Bergen 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.


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If Donating by Credi 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: 201-457-1066

OR

If paying by check or credit card, mail to:


Habitat for Humanity of Bergen County

10 Banta Place, Suite 105

Hackensack, NJ 07601


Please do not hesitate to call us if you have any questions:  (201) 457-1020

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