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Donation Form
Please print this page, complete form and mail.
 
Date ____/____/____
 
Name _________________________________________________________________________ 
 
Address _______________________________________________________________________
 
City/State/Zip __________________________________________________________________

Phone (______ )_________________ E-mail _________________________________________
 

 


 
Donation Amount
 
I want to invest in the future of Pregnancy Support Center of Ulster County and a brighter future in general for those needing their services!
 
Here’s my tax-deductible donation of:
 
$25_____   $30_____    $50_____   $100_____   $250_____    $500_____  $1000_____
 
Other amount $________________
 


 

Method of Donation

 
Credit Card    ____MasterCard  ____Visa  ____Discover  ____American Express
 
Name on Card ________________________________________________________________

Card Number _________________________________________________________________
 
Exp. Date (mm/yy) _____________________ Secure Code (three digits): ________________
 
Signature ____________________________________________________________________

Checks or Money Orders     Payable to Pregnancy Support Center     
 

 
Mail Donation and Completed Form
 
Pregnancy Support Center of Ulster County
246 Main St. Suite 9
New Paltz, NY 12561
 

The Pregnancy Support Center of Ulster County is a 501(c)(3) not-for-profit organization
and your donation is tax deductible. We appreciate your support!