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Help
make a difference in someone's life by providing one of the
items listed below.
The
following items are sorely needed. Please circle the following
areas you can give support with to help our clients:
- Utilties
(A) 50% (B) 100% (C) One Month
(D) Deposits
- Bus
Tickets (A) Daily (B) Weekly (C)
Monthly
- Clothing
Assistance (A) Men's (B) Women's (C)
Children
- Personal
Hygiene (A) $10 (B) $30 (C)
$50 (D) $100
- Healthcare
Items (A) $10 (B) $30 (C) $50 (D)
$100
- Food
Boxes (A) One (B) Two (C) Three
(D) As needed
- Move-In
Costs (A) $200 (B) $300 (C) $500
(D) $600
- Furniture
(A) Beds (B) Tables (C) Dishes (D)
Chairs
- Job
Assistance (A) Yes (B) No
- Gas
Tickets (A) $20 (B) $30 (C) $40
(D) $50
- Sponsor
(A) Studio $500 (B) One Bedroom $600 (C)
Two bedroom $700
- Linens
- All types
- Daycare
assistance
- Life
skills service - All types
- Medical
assistance
Company:
___________________________________________________________________________________
Address: _________________________________________________
State: ___________ Zipcode: _________
Phone: ___________________________________________ Fax: ______________________________________
Contact Person: ______________________________________________________________________________
Thank
you for your support. Please fax form back to (602) 266-1643.
Return
to Donation Page.
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