INWOOD HOUSE We Help Teens Take Charge of Their Lives DONATION FORM Complete and mail this form along with your donation to Inwood House support Inwood House, or fax it to Bianca Baquerizo, 320 East 82nd Street Development Department at (212) 861-3791 New York, NY 10028 (212) 861– 4325 Name: Credit Card Type: (AMEX, MC, VISA) Address: Credit Card Number: City: State: Zip: Expiration Date: Home Phone: Business Phone: Signature: E-Mail: How did you find out about Inwood House? Gift Amount: Date: Comments: Mail form and check (i.e. specific program, in memoriam, honor of, etc.) (made payable to Inwood House) to: Inwood House Development Department 320 East 82nd Street New York, NY 10028 Fax (or mail) this form with your credit card information to Bianca Baquerizo at (212) 861-3791 I would like to sign up for the Inwood House mailing list. I would like to receive Inwood House We thank you for your support! updates by e-mail.