a Donation Form (PDF)

Pure Water Movement
www.PureWaterMovement.org
Charitable Contribution Form
Providing Pure, Clean Drinking Water To Those Who Served & Protected Us
An estimated 40% of San Diego County's homeless are military veterans. An example of some of
the struggles homeless individuals face are finding clean water, food, shelter, illness prevention,
etc. One of the biggest issues of the ones on this list is finding clean water. This lack of
accessibility to clean water has led to many homeless individuals to either dehydrate themselves,
which causes many illnesses and health problems, or drink dirty water, which has many health
implications as well.
~Please join us in the cause to deliver pure water to homeless veterans
Please accept my financial contribution of $
Name:
Company
Address:
City
Telephone(
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I wish to pay by credit card
Card #:
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State
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MasterCard, VISA or American Express (circle one)
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Expiration date
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Date
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3 or 4 digit security code on reverse side of card
Signature
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Enclosed is a check made payable to Pure Water Movement (Tax I.D. #46-2386790). Pure Water Movement is a
501 (c)(3) non-profit organization and your contribution is tax deductible to the extent allowed by law.
Date
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Check number
Thank you for your support!
Please return to: Pure Water Movement
1501 San Elijo Rd., Suite 104-406, San Marcos, CA 92078