Form #100

Habitat for Humanity of Lee and Hendry Counties shall make every effort to use funds as designated; nevertheless, under the direction of the Board of Directors, Habitat retains complete control over the use and distribution of donated funds in furtherance of its mission.

Please print and complete this form and mail it along with your donation to:

Habitat for Humanity of Lee and Hendry Counties
1288 N. Tamiami Trail
North Fort Myers, FL. 33903

Be sure to enclose your check or your credit card information.

Donor Information:

Name:____________________________________________

Address:____________________________________________

City:____________________________________________

State:_________________

Zip:_________________

E-Mail Address:____________________________________________

Payment Information:

Enclosed is my check for:$_________

Please charge my gift of:$_________

Payment Method:Visa / Mastercard / American Express / Discover

Account No._____________________________________

Exp. Date___________

Signature_____________________________________

Phone Number_____________________________________

Gift Comment or Notes_____________________________

Please make checks payable to Habitat for Humanity of Lee and Hendry Counties.

All gifts are tax-deductible to the extent allowable by law.
For more information, call 239-652-0434
To donate by fax: 239-652-0386

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