86 Friend Street, Amesbury MA 01913
whittierhome@verizon.net 978.388.1337
  

Donation form 

Whittier Home Association is a 501(c)(3) non-profit organization

For Your Record

Amount of contribution: $_______.____

Check___

Credit Card___

Date mailed: ____/____/____

 

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Keep this portion for your own records
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Classification:     ___Individual     ___Corporation     ___Foundation

Name______________________________________________________________

_______________________________________________________________

Address 1___________________________________________________________

Address 2___________________________________________________________

City_________________________________ State_______ Zip________________

Amount of contribution:   $___________._____

___Check enclosed payable to Whittier Home Association

___I prefer to pay by credit card         ___MasterCard         ___Visa         Security Code________

Name on card________________________________________________________

Card number_________________________          Expiration date________/________

Mail this form (with your check) to: Whittier Home Association, 86 Friend St, Amesbury MA 01913