Please print this form. It cannot be completed on line.
Enclosed is a gift of $___________ to support the work of Connections for the Homeless.
Name__________________________________________________________________
Address________________________________________________________________
City_______________________________State_____________Zip_________________
Phone________________________ Email______________________________________
Payment method:
¨ Check: payable to Connections for the Homeless
¨ Visa or MasterCard Acct #_____________________ Exp.date_____
Signature______________________________________________
Contributions are tax-deductible to the extent allowed by law.
Gift is ¨ in memory of:____________________ ¨ in honor of:______________________
Please send an acknowledgement of this gift to:
Name______________________________Address_____________________________________
City_______________________________________ State____ Zip________________
¨ Enclosed is a form for my company to match my gift.
¨ Please do not list my/our name on any list of donors.
Please mail this form with your gift to:
Connections for the Homeless • 2010 Dewey Avenue • Evanston, IL 60201
or fax to (847) 864-6558
