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VNHELP Form – 05.2014

VNHELP

DONATION FORM

YES! I would like to support VNHELP

Enclosed is my gift of:

• $25 to feed a hungry child for a month

• $50 to sponsor a free cataract surgery for a poor patient

• $300 to provide scholarship for a low-income university student

• $300 to sponsor an orphan for a year

• $500 to connect 10 families to a clean water source

• $2,000 to install a water filtration system at a primary school

• $4,000 to provide furniture for a kindergarten

• $35,000 to build a new school (with a VNHELP matching fund).

• Other: _____________________________________________________________

Name: ___________________________________________________________________

Address: _________________________________________________________________

City: _____________________________________ State/Zip: _____________________

Telephone: __________________________ Email: ____________________________

Payment Method

• Check [pic] Credit Card [pic] Cash

If paying by credit card, please provide your credit card information:

• VISA [pic] Master Card

Card Number: ____________________________________________________________

Security Code: _______________________ Expiration Date: ____________________

Signature: __________________________________ Date signed: ________________

Additional Comments:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Please make checks payable to:

VNHELP

500 E. Calaveras

Blvd. Suite #235

Milpitas 95035

Contributions are tax-deductible as permitted by law. VNHELP is classified as 501(c)(3) by the IRS. Tax ID: 94-3169584

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