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Online Credit Card Donation Form

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Online Credit Card Donation Form Powered By Docstoc
					  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.

				
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