Lock's of Love Hair Donation Form

TO ENSURE SAFE ARRIVAL, PLEASE DO NOT SEND DONATIONS IN LETTER SIZE ENVELOPES
Please mail your donation to: Locks of Love – 234 Southern Boulevard – West Palm Beach, FL 33405
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Please complete, print and send this form with your donation.
If you wish to send in photos of your donation, please e-mail them to [email protected]e.org with name & address.
Donor Information (please print or type)
Name
Phone
Address
Suite/Apt
City & State
Age (if minor)
Zip Code
Today’s Date
E-MAIL:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Please select how you would like to receive your acknowledgment (choose one)**:
Mail _________ E-Mail__________
**
Please note to receive an acknowledgment by mail may take up to 90 days. By selecting
to receive an e-mail acknowledgment, Locks of Love will be able to send your
acknowledgment more promptly.
Contribution Information
(optional)
I would like to donate: ___ $25 ___$50 ___ $100 ______ Other Amount
Sponsor a Locks of Love child
___$1,000
Payment type: __ American Express __Visa __MasterCard __ Check # ________ __MO
Credit card number: Exp. Date:
Name as it appears on card:
Please make all checks or money orders payable to:
Locks of Love
Comments
Thank you for your donation!
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Lock's of Love Hair Donation Form PDF

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