Please print and complete this form and mail it along with your donation to:

Habitat for Humanity International
121 Habitat Street
Americus, GA 31709-3498

Be sure to enclose your check or your credit card information.

DONOR INFORMATION

Name: ______________________________________________

Address: ____________________________________________

___________________________________________________

City: _______________________________________________

State: ________________ Zip: __________________________

E-Mail Address:_______________________________________


PLEASE INDICATE:

Enclosed is my check for $_________

Please charge my gift of $_________

Visa / Mastercard / American Express / Discover

Account No. ___________________________________

Exp. Date ___________

Signature _____________________________________

Phone Number ________________________________

Please make checks payable to Habitat for Humanity International.
All gifts are tax-deductible to the extent allowable by law.
For more information, call 1-800-422-4828 (1-800-HABITAT).

Habitat for Humanity International makes every effort to honor your designation; however Habitat reserves the right to apply funds to another purpose if in the sole judgement of the Board of Directors of HFHI, the original designation becomes, in effect unnecessary, incapable of fulfillment, or inconsistent with the charitable needs of the community or area served.

Form #101w02