Contribution Form

All Contributors Please Complete

Please select one
 $24,000 $12,000 $5,000 $2,500 $1,500 $1,000 $ 500 $250 Other $

Your Name (required)

Spouse's Name

Address (required)

City
State Zip

Phone

Fax

Email (required)

Occupation (required)
 Retired

Employer (required)
(if self-employed, list name of company)

CREDIT CARD CONTRIBUTIONS:

Amount of Contribution:
 Mastercard Visa AMEX

Credit Card Number

Expiration Date

Is this a corporate card?
 Yes No

Corporation Name

If this is a corporate card, by law it will be considered a corporate donation.

Billing Address for Card

 

FOR MORE INFORMATION CONTACT: MARY AT 818.818.477.0793 OR mary@glendalecommunitasinitiative.org

Please make checks payable to The Community Foundation of Verdugos

The Community Foundation of Verdugos manages funds for The Glendale Communitas Initiative.
*The Community Foundation of the Verdugos is a public 501(c)(3) entity EIN #95-6068137 whose work is for the benefit of the community.
Your gift is tax deductible to the extent that is allowed by law.

Kindly send completed form and contribution to:

Mary Khayat
c/o Community Foundation of Verdugos
111 East Broadway, Suite 200 – Glendale – CA – 91205