Habitat for Humanity of Ouachita

DONATION FORM

Is this your first donation to Habitat for Humanity of Ouachita?

___ Yes      ___ No

Donation Amount:______________

Your Information:

Name:__________________________________

Address:____________________________

____________________________

City:____________________________

State:____________________________

Zip:____________________________

Phone Number:____________________________

E-mail:____________________________

Would you like to subscribe to Habitat for Humanity of Ouachita's newletter?

___ Yes      ___ No

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Habitat for Humanity of Ouachita will honor all donations made in memory or

in honor of individuals and groups with a gift announcement mailed to

your designee.  To designate your donation, please complete the following:

____Honorarium    ____Memorial

Name of Honoree: ____________________________

Please mail acknowledgement card to:

First Name:____________________________

Last Name:____________________________

Address:____________________________

City:____________________________

State:____________________________

Zip:____________________________

Phone Number:____________________________

E-mail:____________________________

Please allow 8-10 working days for your acknowledgement card to reach its

destination.

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Habitat for Humanity of Ouachita

1220 N 18th, Suite 303

Monroe, LA 71201

Please do not hesitate to call us if you have any questions:  (318) 323-8003

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