Habitat Birmingham

DONATION FORM

Is this your first donation to Habitat Birmingham?

___ Yes      ___ No

Visa & MasterCard accepted.

Donation Amount:______________

Donor's Information:

Name:__________________________________

Address:____________________________

____________________________

City:____________________________

State:____________________________

Zip:____________________________

Phone Number:____________________________

E-mail:____________________________

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Habitat Birmingham honors donations made In Memory Of 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 5 working days for your acknowledgement card to reach its destination.

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If Donating by credit card, enter the following information as it appears on card:

Name:____________________________

Credit Card Number:____________________________

Card Expiration:____________________________

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If paying by credit card you may fax this completed form to: 

205-780-1800 or mail to:

Habitat for Humanity of Greater Birmingham

4408 Lloyd Noland Parkway

Fairfield, AL  35064

Questions? Please call 205-780-1234

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