Habitat for Humanity, Prince William County, Manassas & Manassas Park

DONATION FORM

Is this your first donation to Habitat for Humanity, Prince William County, Manassas & Manassas Park?

___ Yes      ___ No

Visa & MasterCard accepted.

Donation Amount:______________

Your Information:

Name:__________________________________

Address:____________________________

____________________________

City:____________________________

State:____________________________

Zip:____________________________

Phone Number:____________________________

E-mail:____________________________

Would you like to receive Habitat PWC newsletters?

___ Yes      ___ No

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Habitat for Humanity, Prince William County, Manassas & Manassas Park will honor all donations made in memory or

in honor of individuals and groups with a gift announcement mailed to

your designee.  To designate your donation, please complete the following:

____Honorarium    ____Memorial

Name of Honoree: ____________________________

Please mail acknowledgement card to:

First Name:____________________________

Last Name:____________________________

Address:____________________________

City:____________________________

State:____________________________

Zip:____________________________

Phone Number:____________________________

E-mail:____________________________

Please allow 8-10 working days for your acknowledgement card to reach its

destination.

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If Donating by Credit Card, please enter the following information as it

appears on your credit card:

Name:____________________________

Credit Card Number:____________________________

Card Expiration:____________________________

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If paying by credit card you may fax this completed form to: (703) 393-2878

OR

If paying by check or credit card, mail to:

Habitat for Humanity, Prince William County, Manassas & Manassas Park

P.O. Box 3111

Manassas, VA 20108

Please do not hesitate to call us if you have any questions:  (703) 369-6708

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