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Donation Form

Yes, I want to make a difference in the lives of young women!

I would like to make a gift of (circle one):

$1,000     $750     $500     $250     $ 100     Other _________

     Designte the gift to: _____________________________

Please enclose a check made payable to YWLCS or provide information about charging your donation below.

Charge (circle one):

Master Card          Visa          Discover          American Express

Acct.# ______________________________________________

Exp. Date _________________  Card Security Code _________

YWLCS is a 501(c)(3) organization and your gift is tax deductible to the fullest extent allowed by law.

This contribution is made by:

Name _______________________________________________
              (Your name as you wish to be listed as donor.)

Street _______________________________________________

City/State/Zip ________________________________________

Home Phone (_____)___________________________________

Business Phone (_____)_________________________________

Fax Number (_____)____________________________________

e-mail address ________________________________________

Please send notification of this gift to:

Name __________________________________________

Address ________________________________________

___ I wish to donate anonymously.

___ My employer has a matching gift program and I will contact them to provide YWLCS with the necessary forms.

Print this form and mail to us at :

YWLCS
2641 S. Calumet Ave.
Chicago, IL 60616

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