Family Support Network of the Sandhills

Donation Form

Please PRINT and MAIL this form, along with your donation to our address below.

Contact Information

Your Name

Address

City

State

Zip

Phone

Email

Please indicate your gift amount below (check/money order payable to FSN Sandhills).

___In-Kind Contribution Cash Value: $______________

An In-Kind Contribution is a gift that is not in the form of cash or check. You may contribute to the program by donating office supplies such as printing materials, furniture or other things in that manner. Services rendered are also considered "in-kind" contributions. Services can include printing, providing food supplies or child care services.

Please describe the type of contribution or service you can provide below:

_______________________________________________________________________________________________

This Gift is a tribute in honor/memory of: Relationship

_________________________________________ _____________________

FSN of the Sandhills likes to Thank You for your contribution by listing your name in all publications as well as on our website.

Please indicate below if you would like to publicly be recognized for your gift.

YES - Please print my name as ____________________________________________________

NO Thank You please keep my contribution private

________________________________________________________________ ______________________
Signature Date

THANK YOU!

Once we receive your gift we will mail you your receipt.

Please mail completed form along with your donation to:

Family Support Network of the Sandhills
PO Box 569
Southern Pines, NC 28387

Indicates Response Required


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