WAO Printable Donation Form- fax completed form to
212.674.3057
- or - - mail completed form to
WAO National Office
250 Park Avenue South
New York, NY 10003
- WAO National Office
250 Park Avenue South
New York, NY 10003
| WAO Printable Donation Form |
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If you are making your donation by credit card, be sure to provide all the required card and cardholder information. Then:
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If you are donating by check, please be sure your check is signed and dated. Then mail completed form (with check) to:
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| Your Gift (check one): | |||||
| __ $36 | __ $75 | __ $136 | __ $286 | __ $536 | __ $1,000 |
| __ Other amount: ____________ | |||||
| Donor Info: | |
| Donor Name: | ____________________________________ |
| Street Address: | ________________________________________________ |
| City: | ____________________________________ |
| State: | ____________________________________ |
| ZIP: | __________ |
| Country: | ____________________________________ |
| Phone: | ___________________ |
| Email Address: | ____________________________________ |
| ___ You may send me periodic updates via email. | |
| Credit Card Info: | |
| Credit Card Type: | __ Visa __ Mastercard __ American Express |
| Name on Card: | ____________________________________ |
| Card Number: | ____________________________________ |
| Expiration Date: | Month (MM) ____ Year (YY) ____ |
| Cardholder Info (only if different from Donor Info): | |
| Billing Address: | ________________________________________________ |
| City: | ____________________________________ |
| State: | ____________________________________ |
| ZIP: | __________ |
| Country: | ____________________________________ |
| Phone: | ____________________ |
| Gift or Memorial Donation (optional): | |
| Name: | ________________________________ This is a: __ Gift __ Memorial |
| WAO can send a card in recognition of your gift or memorial donation. If you would like us to do so, please complete the following information. | |
| 1. Who would you like the card sent to? | |
| Name: | ____________________________________ |
| Address: | ________________________________________________ |
| City: | ____________________________________ |
| State: | ____________________________________ |
| ZIP: | __________ |
| Country: | ____________________________________ |
| 2. Personalize your card: | |
| To: __________________________ From: __________________________ | |
| 3. Personalized inscription (optional) - up to 25 words: | |
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