Habitat for Humanity Calcasieu Area
DONATION FORM

Is this your first donation to Habitat for Humanity Calcasieu Area?

___ 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 Calcasieu Area's newletter?

___ Yes      ___ No

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Habitat for Humanity Calcasieu Area 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: (337) 497-0470
OR
If paying by check or credit card, mail to:

Habitat for Humanity Calcasieu Area
3551 Avanue C
Lake Charles, LA 70615

Please do not hesitate to call us if you have any questions:  (337) 497-0129

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