DONATION/GIFT FORM


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