Humane Association of Warren County

Name:

Email Address:

Street Address:

City, State:

Zip:

Telephone:

I wish to support the Humane Association of Warren County and make my donation in the following manner:

Amount of Donation For a gift of $25 or more to ANY fund, you can make your gift in honor or memory of a family member, pet or friend. We will send an email message or letter acknowledging that a donation has been made in their honor. Please indicate if this is a special occasion.
I would like to make my donation in honor or memory of:
Full Name:
	Family Member Friend Pet
Occasion:
	Please send an email message acknowledging my donation to the above.
Email:

	I prefer a letter to be sent to the above acknowledging my donation.
Please send letter to:
Address:
City:
State:	Zip:

	No, Thank You. Do not send an email or a letter.

I would like to designate my donation to one of the selected funds:

Credit Card:

Card Number:

Expiration:

By clicking "submit" I authorize you to make the
transaction as indicated above: