Benton Habitat for Humanity
DONATION FORMIs this your first donation to Benton Habitat for Humanity?
___ Yes ___ NoDiscover, Visa & MasterCard accepted.
Donation Amount: ______________
Your Information:
Name: __________________________________________Address: _________________________________________
City: ___________________ State: _____ Zip: _________
Phone Number: (______)_____________________________
E-mail: ___________________________________________
Would you like to subscribe to Benton Habitat for Humanity's quarterly Newsletter?
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Benton Habitat for Humanity 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
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If Donating by Credit Card, please enter the following information as it
appears on your credit card:Name: __________________________________________
Credit Card Number: _______________________________
Card Expiration: ___________________________________
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If paying by credit card you may fax this completed form to (541) 752-3075
OR
If paying by check or credit card, mail to:Benton Habitat for Humanity
PO Box 1551
Corvallis, OR 97339Please do not hesitate to call us if you have any questions: (541) 752-3354