Bless The Kids Foundation - Mail Donation Form

Please print and complete the mail donation form below.

Name:_____________________________________

Address:___________________________________

City:_______________________

State:___________

Zip:__________

Phone:___________________________

E-Mail:_____________________________________

My contribution amount is: $25 $50 $100 $250 $500 Other: $________

Beginning ____/_____/_____, I would like to contribute installments of $____________.

Twice Yearly Quarterly Monthly

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My check made payable to "Bless The Kids Foundation" is enclosed.

--Or-- Please charge my MasterCard Visa AmEx

__________-__________-__________-__________        ____/____          __________
Card number                                                                        Exp. date       CV2# (Last 3 on back)

______________________________________                        ____/____/_____
Signature                                                                                               Date

Bless The Kids Foundation
P.O. Box 140445 Station B
Howard Beach NY, 11414