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

Habitat for Humanity of Douglas County
911 State Highway 29 N Suite 200
Alexandria, MN 56308
Phone: (320) 762-4255
Fax: (320) 762-1580

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

DONOR INFORMATION

Name: ______________________________________________

Address: ____________________________________________

___________________________________________________

City: _______________________________________________

State: ________________ Zip: __________________________

E-Mail Address:_______________________________________


PLEASE INDICATE:

Enclosed is my check for $_________

Please charge my gift of $_________

Visa / Mastercard / American Express / Discover

Account No. ___________________________________

Exp. Date ___________

Signature _____________________________________

Phone Number ________________________________

Please make checks payable to Habitat for Humanity of Douglas County.
All gifts are tax-deductible to the extent allowable by law.
For more information, call (320) 762-4255.