Gift Form

Mail the form (and check, if applicable) to:

Des Plaines Community Senior Center
515 E. Thacker Street
Des Plaines, IL 60016


Name:
Title:
Organization:
Address:
City/State/Zip:
Daytime Phone Number (NNN-NNN-NNNN):
Fax Number (NNN-NNN-NNNN):
E-mail Address:
My Capital Campaign Gift is:
Signature
Date (MM/DD/YYYY)


I will begin my gift with the enclosed check payable to : Des Plaines Community Senior Center
I will contribute monthly
I will contribute quarterly
I will contribute annually
Please charge my Visa/MasterCard for $________________

Card Number:     Expiration Date (MM/YYYY):

Thank you for your support! Your donations are tax-deductible as charitable contributions.