DONATION REQUEST FORM

 

NAME:__________________________________________________________________________________________________________________________

 

ADDRESS:______________________________________________________________________________________________________________________

 

CITY/STATE/ZIP CODE:___________________________________________________________________________________________________________

 

PHONE NO.:_____________________________________________________________________________

 

EMAIL:__________________________________________________________________________________

 

DATE SUBMITTED:________________________________________

 

AMOUNT OF DONATION: $_____________________________ CASH [   ]   CHECK [   ]   CREDIT CARD [   ]

 

CREDIT CARD NO.:________________________________________________________________________

 

EXPIRATION DATE:____________ SECURITY CODE:____________

 

SIGNATURE:______________________________________________________________________________

 

Please mail this form to Soroptimist International of Portland

  P. O. Box 6985

                           Portland, Oregon 97228-6985

Or email to: wandacosti@gmail.com

 

Thank you for your kind and generous donation. All funds are used in our service projects to improve

the lives of women and girls through programs leading to social and economic empowerment.

 

Visit our website at www.soroptimistpdx.org to follow our events and giving.

 

To comply with the IRS requirements regarding charitable donations, we affirm that no goods or services have been provided to you, in

whole or in part, in consideration for your contribution. This letter will serve as confirmation of your donation for income tax purposes.

 

Soroptimist International of Portland is a 501(c)(3) non-profit organization, #93-6026066