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| Three Easy Ways of Donating Now: |
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1. TO DONATE YOUR CAR follow this link
2. Fashion Show Reservation information - scroll down
3. With the PayPal button:
OR
3. PRINT THIS PAGE and mail it in with your check or credit card information to:
Valley Community Clinic
6801 Coldwater Canyon Ave., Ste. 1B
North Hollywood, CA 91605
Attention: Development Department
QUESTIONS?
Prefer to give credit card details directly to a Development staff member?
Please call: 818/301.6350 |
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| THIS DONATION IS FOR: |
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1. FASHION SHOW RESERVATIONS - October 9, 2010 ____
$150 - VIP Seating
$100 - General Seating
Reservations can also be paid for
through PayPal (above)
2. GENERAL DONATION____
3. IN MEMORY___/HONOR___ of:
NAME:__________________________________
MAILING ADDRESS:_______________________
CITY:__________________________________
STATE: __________ ZIP CODE: __________
DAY PHONE: ________________ EVENING PHONE: ________________
EMAIL: _______________________________________
_______________________________________
**Please send tribute gift notification to:
_______________________________________
_______________________________________
Is there a particular program/purpose you would like your donation to go toward? (Otherwise, it will be used where needed most):
_______________________________________
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| CHECK ENCLOSED ___ |
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Amount: _______________ |
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| CREDIT CARD ___ |
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__ Mastercard or __ Visa ONLY
Name on Card:_____________________
Account Number: __________________________
Billing Address:____________________________
City:_______________State____ ZIP____
Last 3 Digits of number on the back of the card: ________________
Expiration Date: _______________
Amount to be Charged: ______________
OR
Monthly Amount to be charged on the 30th of each month: _______________ |
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| THANK YOU FOR YOUR DONATION! |
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Valley Community Clinic is a private, non-profit 501(c)(3) charitable organization and all gifts are 100% tax deductible.
The Clinic Federal Identification # is 23-7050082
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Copyright ©2003 Valley Community Clinic All Rights Reserved.
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