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Credit Card Submittal Form

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					      Donation and/or Credit Card Submittal Form
                 May only be used for gifts of $50 or more.

    Please complete the information requested below to charge
      your Oaks Foundation contribution to your credit card.
      Fax this form to 330 938-7406 or return it in the mail to:
         John Stilts, Administrator, The Oaks Foundation,
          715 S. Johnson Road, Sebring, OH 44672-1709.


Title:
First Name:                                               Middle Initial:
Last Name:
Spouse's Name:
(if a joint
contribution)
As it appears on your credit card billing statement
Address:
City:
Postal Code:
Country:
Daytime
Telephone

                     This Gift Designated for: The Oaks Foundation

Please use my gift for( ex. Life Care Support)___________________________


          Amount of Gift          $
        (U.S. Currency only)
   Please Charge My Gift to:
   Visa, Mastercard, Discover,
       American Express
      Name on the Card:
     Credit Card Number:
        Expiration Date:
         Example: 05/07
Honor or Memorial Designations/Comments:

				
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