Please print and complete this form and mail it along with your donation to:

LHEF, Inc.
484 14th Street
Brooklyn, New York 11215


Be sure to enclose your check or your credit card information. Please note that the only credit cards we accept are VISA and Mastercard.


DONOR INFORMATION

Name: _______________________

Address: _______________________

_______________________________

City: ___________________________

State: _________    Zip: ____________

E-Mail Address: ______________________
(if you would like to be informed of upcoming events)


PLEASE INDICATE:

Amount of Donation: $_________

Optional:

Donation is in honor or memory of:

_____________________

Please check one of the following to indicate the form of the donation:

_____   check   _____   money order   _____   cash   _____   credit card  

Please make checks payable to LHEF, Inc. 


For Credit Card Donations:
Please note that your donation will appear as a payment to "LHEF, Inc." on your credit card statement.

Type of Card (check one):  _____   VISA   _____   Mastercard

Name on Credit Card: _____________________

Billing Address: __________________________

______________________________________

Phone Number: ____________________

Today's Date: ______________

Account No.: __________________________

Exp. Date: _________

Amount to be deducted: $_________

Signature: _________________________




LHEF, Inc. is a non-profit organization. Your donation is tax-deductible.

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