BRIMMING WITH HOPE Printable donation remittance form Print out and complete by hand or typewriter *one hat costs approximately $5.00 [ ] Enclosed is my *gift of: [ ] $5 [ ] $100 [ ] $250 [ ] $500 [ ] Other $___________________ [ ] I/We prefer to use a credit card. Please charge: [ ] Visa [ ] MasterCard Acct #___________________________________Exp. Date_______________________ Name as it appears on card:________________________________________________ Signature_________________________________Date__________________________ [ ] My employer will match my gift. I have enclosed my company’s form. Name (s) (as you wish to be acknowledged)____________________________________ Address___________________City_______________State_____Zip________________ My gift is: [ ] In honor of_____________________________________________________________ [ ] In memory of___________________________________________________________ [ ] Other Occasion (i.e. Birthday, Christmas-please specify)_________________________ [ ] Anonymous____________________________________________________________ Name of person to be remembered or honored as you would like it to appear on the acknowledgement: (Please Print)______________________________________________________________ Please send acknowledgement of this gift to: Name____________________________________________________________________ Address__________________________City_______________State_____Zip___________ Make your check payable to Hats With Heart and mail, along with this form, to: 530 W. 9460 S. Suite A, Sandy, UT 84070 801-567-0066 THANK YOU FOR YOUR SUPPORT!
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