To submit
your contribution, simply print this page, (checks should be made payable
to Promise House), and mail to: Promise
House, Inc.
Promise House Contribution Form
224 West Page
Dallas, TX 75208
Enclosed is my contribution in the amount of $ ______________________ payable to Promise House.
Please charge my credit card as indicated below for my contribution of $ _______________________
(check one:) MasterCard:___________ Visa:____________ Check/Money Order: _____________
Account #: _________________________________________________________________________
Expiration Date: ____________________ Three-digit code on the back of the card: _____________
Authorized Signature (required): ________________________________________________________
This gift is:
________ In memory of:
______________________________________________________________
________ In honor of:
________________________________________________________________
Please specify the occasion: ____________________________________________________________
Please send acknowledgement to:
Name:
(Last)_____________________________ (First)____________________________
(MI)_____
Address: ___________________________________________________________________________
City: ____________________________________ State: _________ Zip Code:
_________-_________
From:
Name:
(Last)_____________________________ (First)____________________________
(MI)_____
Address: ___________________________________________________________________________
City: ____________________________________ State: _________ Zip Code:
_________-_________