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Friends in Action of the Eastern Panhandle Donation Form
Please print this form, complete it, and mail it with your check, payable to Friends in Action of the Eastern Panhandle, to:
Friends in Action of the Eastern Panhandle
PO Box 1720
Shepherdstown, WV 25443
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I am making a gift/pledge in the amount of (please check one):
___$50 ___$75 ___$100 ___$250 ___$500 ___(Other)
Name: ___________________________________________
Address: _________________________________________
City: ____________________________________________
State: ___________________________________________
Zip Code: _______________________________________
Phone: __________________________________________
E-mail: __________________________________________
In Memory/Honor of (you may make your gift in honor/memory of someone).
To do so, please complete the information below:
( ) In Honor ( ) In Memory of
Person(s) in honor/memory of: ______________________________________________
Person(s) to notify of your gift (amount not disclosed):
Address: ________________________________________________________________
CREDIT CARD INFORMATION:
( )
Visa ( ) MasterCard
Card Number: _________________________________
Expiration Date: ____ /____
CCV: ____
MATCHING GIFT PROGRAM
You can double or triple the size of your gift if you or your spouse is
employed by a company with a matching gift program. These companies often match
contributions of their retirees too. All you need to do is obtain this form,
fill out your portion, and send it to us. We will take care of the rest.
( ) Enclosed is my company’s matching gift form