.

MEMORIAL/DONATION FORM


(Right-Click on this page to print it out,
fill it out and return it with your gift to Crossroads House)

CROSSROADS HOUSE

I would like to make a donation of $__________________

in memory/honor of:______________________________

Please send notification of this gift to:

Name:__________________________________

Address:________________________________

City:____________________________________

State:___________________________________

Zip:_____________________________________

From:

Name:__________________________________

Address:________________________________

City:____________________________________

State:___________________________________

Zip:_____________________________________

Please make checks payable to:

Crossroads House

P.O. Box 403

Batavia, N.Y. 14021

May the knowledge that your gift will help others bring joy to you.

Thank you!

Top