Donation Form

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Please print this form, fill in the required info and return with your contribution

( ) Yes, I/we would like to contribute to Azalea Charities

Enclosed is a contribution of $ _____________ Check #:____________ Check date:__________________

Please allocate my donation in the following percentages:

______% Aid to Wounded Soldiers

______% Community Charities

( ) Yes, please keep us on the annual membership mailing list.

Make checks payable to: Azalea Charities

Mail to:
Azalea Charities, Inc.
P.O. Box 579
Dumfries, VA 22026

EIN No.54-1973354 -501(c)3

If you wish to claim a tax deduction please include a self-addressed stamped envelope for return of a receipt.

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Name

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Address

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City/State/Zip

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Phone (optional)

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E-mail (optional)