Please print and complete this
form and mail it along with your donation to:
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.
State: _________ Zip: ____________
E-Mail Address: ______________________
(if you would like to be informed of upcoming events)
Amount of 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
Name on Credit Card: _____________________
Billing Address: __________________________
Phone Number: ____________________
Today's Date: ______________
Account No.: __________________________
Exp. Date: _________
Amount to be deducted: $_________
LHEF, Inc. is a non-profit organization. Your donation is tax-deductible.