Please accept my gift of $ _________ as a contribution to:

Donor’s Information:

 

Name:       ______________________________________________________________

 

Address:   ______________________________________________________________

 

City:  __________________________  State:  _____________  Zip:  ______________

 

Phone Number:  ________________________________

 

 

 

My gift is in memory of:  _________________________________________________

 

My gift is in honor of:      _________________________________________________

 

 

Please notify the following individual of my gift:

 

Name:       ______________________________________________________________

 

Address:   ______________________________________________________________

 

City:  __________________________  State:  _____________  Zip:  ______________

Please make checks payable to:

 

Hospice Care of Southwest Michigan

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Please print and mail this form along with your check to:

 

        Hospice Care of Southwest Michigan

        222 N. Kalamazoo Mall, Suite 100

        Kalamazoo, MI  49007-3882

Thank You

Your contribution is deductible to the fullest extent of the law.

Hospice provided no goods or services in consideration of your contribution.

 

For questions or concerns please call 269-345-0273.

Support Through Giving