Thank yo
ou for suppo
orting your ffriend’s perssonal fundraaising campaaign! Your ggift helps Thee Humane Society of tthe United SStates stop aanimal cruellty and suffeering wherevver it occurss. Please prrovide your information
n using the form below, and return this form
m with yourr donation
n to the follo
owing addre
ess: US | myHumaane HSU
Attnn: Carie Lewiis Carlson 700 Professionaal Dr. MD 20879
Gaitthersburg, M
Fundraiser Information (* requiired) *Fundraiser First Nam
me: _______
__________
___________________________________________ *Fundraiser Last Nam
me: _______
___________
_________________________________________ Fundraiser City/State
e: ________
___________
_________________________________________
Fundraiser Campaign
n Name: ___
___________
_________________________________________
(This is the title that ap
ppears at the top of the fun
ndraiser’s perrsonal fundraaising page.) Gift Inforrmation
Gift Amo
ount (check o
one): $35 $50 $100 $250 $500 $1,000 Other Amoun
O
nt: $_______
____ This gift is anonymous. Paym
ment Type:
Check Credit orr Debit Card Card Number: _______________________ Expiratio
on Date: _________ Security//CVV: ___________ Signaturre: ______________ (required)
(Iff checked, your n
name will not ap
ppear on the pub
blic list of donors
rs on the fundraiiser’s personal page. The fundra
aiser will be able to vie
w
w your contribution privately, ho
owever.) Donor In
nformation (* required))
*First Naame: ______
___________
________ *Lasst Name: _________________________
*Street A
Address: ___
___________
__________
___________________ A
Apt./Suite: _____________ *City: __
___________
___________
_______
*State: ____
____ **ZIP Code: _____________ *Email Address: ____
__________
___________
______________ PPhone: ________________