Enclosed is my gift of $ _______________
(Please make checks payable to Vincent House)
In memory of ____________________________________
To honor ________________________________________
Occasion:
Memorial
| Birthday | Anniversary | Marriage | Holiday | Gift
Donor’s
Name : _______________________________________
Address: _____________________________________________
_____________________________________________________
City/State/Zip: ____________________________________________
Please notify the person below of my gift :
Name : ________________________________________
Address: _______________________________________
_______________________________________________
City/State/Zip: ____________________________________________
Please Mail Forms and Checks to : Vincent House - 310 2nd Street
- Wayland, NY 14572