Bayou Area Habitat for Humanity
DONATION FORM

Is this your first donation to Bayou Area Habitat for Humanity?

___ Yes      ___ No

Discover, Visa & MasterCard accepted.

Donation Amount:______________
Your Information:

Name:__________________________________

Address:____________________________

____________________________

City:____________________________

State:____________________________

Zip:____________________________

Phone Number:____________________________

E-mail:____________________________

Would you like to subscribe to Bayou Area Habitat for Humanity's newletter?

___ Yes      ___ No

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Bayou Area Habitat for Humanity will honor all donations made in memory or
in honor of individuals and groups with a gift announcement mailed to
your designee.  To designate your donation, please complete the following:

____Honorarium    ____Memorial

Name of Honoree: ____________________________

Please mail acknowledgement card to:

First Name:____________________________

Last Name:____________________________

Address:____________________________

City:____________________________

State:____________________________

Zip:____________________________

Phone Number:____________________________

E-mail:____________________________

Please allow 8-10 working days for your acknowledgement card to reach its
destination.

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If Donating by Credi Card, please enter the following information as it
appears on your credit card:

Name:____________________________

Credit Card Number:____________________________

Card Expiration:____________________________

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If paying by credit card you may fax this completed form to: (985) 447-5167
OR
If paying by check or credit card, mail to:

Bayou Area Habitat for Humanity
1087 Highway 3185
Thibodaux, LA 70301
ph. (985) 447-6999

Please do not hesitate to call us if you have any questions:  (985) 447-6999

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