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Please print and complete this
form and mail it along with your donation to:
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LHEF, Inc.
P.O. Box 1258
New York, NY 10116
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Be sure to enclose your check or your credit card information. Please
note that the only credit cards we accept are VISA and Mastercard.
DONOR INFORMATION
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Name: _______________________
Address: _______________________
_______________________________
City: ___________________________
State: _________ Zip: ____________
E-Mail Address: ______________________
(if you would like to be informed of upcoming events) |
PLEASE INDICATE:
Amount of Donation: $_________
Optional:
Donation
is in honor or memory of:
_____________________ |
Please check one of the following to
indicate the form of the donation:
_____ check _____ money order
_____ cash _____ credit card
Please make checks payable to LHEF, Inc.
For Credit Card Donations:
Please note that your donation will appear as a payment
to "LHEF, Inc." on your credit card statement.
| Type of Card (check one): _____ VISA
_____ Mastercard |
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Name on Credit Card: _____________________
Billing Address: __________________________
______________________________________
Phone Number: ____________________
Today's Date: ______________
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Account No.: __________________________
Exp. Date: _________
Amount to be deducted: $_________
Signature: _________________________
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LHEF, Inc. is a non-profit organization. Your donation is tax-deductible.
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