Sofia’s
Hair for Health
Donations
form
137Cedarhurst
Ave - Cedarhurst - New York 11516
Phone: 212-327-4227 - Fax 212-327-2619
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Name_________________________________________________________________________
Address_______________________________________________________________________
City/State/Zip__________________________________________________________________
Telephone
(
)_______-________________ email ___________________________________
If
your employer has a matching program, you may be able to DOUBLE
your gift!
Company
/Organization____________________________________________________________
Title___________________________________________________________________________
Address________________________________________________________________________
City/State/Zip___________________________________________________________________
Telephone
(
)______-_______________email______________________________________
Let
me help with a tax deductible contribution in the amount of: 75 100
250 500
1000 other
$
Enclosed is my check payable to SOFIA’S HAIR FOR HEALTH
I am vowing $ ______________________
OR
CHARGE TO:
Amex
MasterCard Visa Discover#___________________________________________________
Exp-date_________________________Signature__________________________________________
Please
automatically charge to my credit card the amount of
$___________________________
Every
month, Quarterly, or in the
following months_____________________________________________
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My
gift is in honor and the memory of
_____________________________________________________
Please
send an acknowledgment to:
______________________________________________________
_________________________________________________________________________________