Youth Matter Inc. / Youth Matter America - DONATION FORM

DONATION FORM

Please print out this page and fill in the information below.

First Name, Last Name

Company Name

Street Address (Example: 1234 Main St, Apt 102)

City, State, Zip

Telephone (Example US: (###)###-####x#### ; Intl: +##-####-####-)

E:mail address

Enclosed is my donation of:
$50 $100 $250 $500 $1,000 $2,000 $5,000 $10,000
Other $______________

Please Make Checks and Money Orders Payable To: Youth Matter, Inc.

      Please Apply My Donation to:

      Visa      Mastercard      Discover      AMEX

     Name as printed on Card___________________________________

     Card#___________________________________________

     Expiration Date___________ (mm/year)

     Signature___________________________________________

When you have completed all of the information, mail it to the following address:

Youth Matter, Inc.
P. O. Box 396
Portsmouth, VA 23705

If you have any questions you can email us.

Youth Matter, Inc. is a 501(c)3 corporation and approved by IRS. Your donation is tax-deductible.

THANK YOU FOR YOUR DONATION & FOR INVESTING
IN THE LIVES OF YOUTH AND FAMILIES.