Donate by Mail Form - American Cancer Society
Please mail this form and your check to: American Cancer Society PO Box 6704 Hagerstown, MD 21741
(Please PRINT all information clearly.) Date: Enclosed is my check in the amount of $
My name: Address: City/State/ZIP: (Receipt will be sent to the address above.)
payable to the American Cancer Society. Phone:
Type of Donation (please choose one):
General Donation
Gift in memory of:
(name of deceased)
Send acknowledgement card to: Name: Address: City/State/ZIP: How would you like the card to be signed?
Gift in honor of:
Send acknowledgement card to:
(name or names) (name of individual)
Name:
Address:
City/State/ZIP:
How would you like the card to be signed?
(name or names)
We thank you for your support.
Your contribution is tax-deductible. To reduce administrative costs, your gift will be processed at a central facility.
The American Cancer Society cares about and protects your privacy. The information you provide to the Society will only be used as described in our
privacy policy, about-us/policies/privacy-statement.html.
?2022 American Cancer Society, Inc.
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