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On-line Donation

Contributions to CARE-A-VAN Services, Inc., a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code, are deductible for computing income and estate taxes. Please provide the following information. You will receive proof of your tax deductible donation shortly.

Enter Gift Amount:    Use of decimal point is required

Card Holder Information

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
 Phone
E-mail

Card Type:   

          Account Number:      

Expiration:     Month         Year:   

Service Information

Visitors providing donations for consumer services must provide the following information to ensure donations are applied to the consumer's case.

Consumer/Passenger Name:

From Date of Service:   To Date of Service:

Comment:

Mail

To submit donations by mail please print and mail this form to:

CARE-A-VAN SERVICES, INC.

Att: Donations

PO Box 6044

Hobbs, NM 88240

 

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Copyright © 2003 [OrganizationName]. All rights reserved.
Revised: 01/15/07