Donation Gift

Please complete the information on this form, print,
and mail with your contribution.


Name:
Address:
City: State: Zipcode:
Phone: () - ext. Home Business

This Gift is being made in memory of:(leave blank if not applicable)


Please Acknowledge:(leave blank if not applicable)
Name:
Address:
City: State: Zipcode:

Amount of Gift $
Cash or Check Enclosed (Please make checks payable to Al Sigl Community of Agencies)
Credit Card (Visa/MasterCard/American Express/Discover)
Charge $
Card # Exp. Date

Signature:________________________________________________________
My company will match my contribution.



Please make checks payable to Al Sigl Community of Agencies.
To expedite gifts of securities, please call Karen Gaffney at 442-4100, ext. 8980 or email kgaffney@alsigl.org
Mail to: Al Sigl., 1000 Elmwood Avenue, Suite 300, Rochester, NY 14620-3098