Donation Form

I want to become a donor to the American Red Cross – Flint River Chapter.

My donation is:

o - $100. o - $500.

o - $150. o - $1,000.

o - $200. o - Other __________

o - $250.

_______ Check enclosed.

_______ Send invoice.

_______ I would like to pay in installments, please contact me.

_______ Charge my credit card number _______________________________, expiration date _________________.

o Visa o Mastercard

Name ______________________________________________

Address _________________________________________________________

Email ______________________________ Phone_________________________

Signature ______________________________________________________

Please print, complete and mail this form to:

1509 Crawford Street, Americus, GA 31709

 

Thank you for your commitment………..

We cannot be here when we are needed the most without

YOU!!