Printable Donation Form

Simply click the "Print" button on your browser then fill out the necessary information and mail or fax it to the address and number found at the end of this form.

With this option, please be sure your credit card information is accurate.

Section 1: Contact Information

If donating by credit card please be sure that this information is complete and applies to the cardholder.

FIRST NAME:

____________________________________

LAST NAME:

____________________________________

MI:

_______

ADDRESS:

____________________________________

ADDRESS:

____________________________________

CITY:

____________________________________

STATE:

____________________________________

ZIP:

____________________________________

PHONE:

____________________________________

FAX:

____________________________________

EXT:

_________

EMAIL:

____________________________________

 

___ I may be contacted by email

 

___ Please do not contact me by email


Section 2: Gift Information

AMOUNT:  (circle one)

   $25    $35    $50    $100    $250    _______ Other

Note: Unfortunately, we are unable to process credit card gifts less than $10.


______ My company will match my gift. I will mail you a copy of the appropriate form from my corporation's matching gift program.


This gift is in  ___ Honor  ___ Memory of: ____________________________


Please notify this person/family of my gift:

NAME:

____________________________________

ADDRESS

____________________________________

PHONE

____________________________________


Section 3: Credit Card and Payment Information

CREDIT CARD NUMBER:

____________________________________

EXPIRATION DATE (MM/YY):

____________________________________

NAME AS IT APPEARS ON CARD:

____________________________________

We accept Visa and MasterCard.

If donating by check or money order, please make it payable to: Sanctuary House.


CONTACT:
Sanctuary House
518 North Elm Street
Greensboro, NC 27401
Attn: Development Office
FAX #: (336) 346-1748

Thank you for supporting the important work of Sanctuary House. After your credit card is authorized, you will receive an official receipt acknowledging this transaction for your tax records.

Again, thank you for your support. Your generosity will help us bring more opportunities to people with mental illness.

If you experience any problems, please call the Sanctuary Development Office at (336) 275-7896 ext. 14.