Animal Humane Society Donation Form

Animal Humane Society Donation Form

Monthly sustaining donation

Sustainers make a difference in the lives of homeless animals all year long and help reduce administrative costs. You choose how much you want to donate ($5 min) and we will automatically deduct your donation from your credit card or bank account once a month.

$7 / mo

$12 / mo

$22 / mo

$52 / mo

$102 / mo

$________ / mo

Authorized signature _________________________________________________ Date ______________________

I authorize Animal Humane Society to process debit entries to my account or credit card. I've attached a voided check or savings deposit slip if called for. This authority will remain in effect until I give reasonable notification to terminate this authorization. I understand that I will be enrolled immediately.

One-time donation

Select an amount below to make a single donation.

$50

$100

$250

$500

$1,000

$________

Payment information

Please complete all applicable information.

My check is enclosed

Charge my sustaining donation to my checking account (must attach a voided check)

Charge my donation to my: Visa

MasterCard

American Express

Discover

Card # ___________________________________________ Expiration date ________________ CVV ______________

Authorized signature ________________________________________________ Date __________________________

Contact information

Please complete all available information. Name _________________________________________________________________________________________________________________________

Address _______________________________________________________________________________________________________________________

City/State/Zip code ______________________________________________________________________________________________________________

Phone _____________________________________ Mobile Home Work

E-mail ___________________________________________________________________________________________ We will not share your information. Providing your email address allows us to communicate efficiently and save resources.

Tributes/Memorials

My donation is in honor or memory of a person or pet.

Pet memorial

Pet tribute

Person memorial

Person tribute

Honoree's name __________________________________________________________________________

Please send a recognition card to:

Name ____________________________________________________________________________________

Address __________________________________________________________________________________

City/State/Zip _____________________________________________________________________________

Please mail completed form and enclosures to:

Animal Humane Society Donor Services Department 845 Meadow Lane N Golden Valley, MN 55422

Questions -- (763) 489-2210

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