Prevent Child Abuse America DONATION FORM
Please print and complete this form and mail it with your
check, money order, or credit card information to:
Prevent Child Abuse America
PO Box 94283
Chicago, IL  60690-9950
 
Name:  ______________________________________________________
Address: ______________________________________________________
  ______________________________________________________
City:  _____________________State:_______ Zip Code: ____________ 
Phone: (_____)___________________________
E-mail:  _________________________________
 
____ Check payable to Prevent Child Abuse America enclosed.
____ I would like to charge a gift to my credit card in the amount of $_______________
 
____ Mastercard ____ Visa
Name as it appears on card:  ____________________________________________
Card Number:  _______________________________Expiration Date:  ___________
Signature: __________________________________
 
Yes, my company has a matching gift program.
____ I have enclosed my company’s matching gift form.
____ I will send my company’s matching gift form.
 
____Please send me the free planned giving strategies booklet.
 
Thank you for your generous contribution to
Prevent Child Abuse America!