American Red Cross of RI - Tribute Gift Form

SE HABLA ESPANOL
Para mas informacion en espanol favor de llamar a Gisela al telefono
(401) 831-7700 x108

Please complete this Tribute Gift Form and mail to:

American Red Cross of Rhode Island
105 Gano Street
Providence, RI 02906
Attn: TRIBUTE GIFT

For any questions regarding tribute gifts, please contact Kristin Wieber, Chief Philanthropy Officer, at [email protected] or call 401-831-7700 x106.

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Donor's Name:

___________________________________

Donor's Address:

___________________________________

City, State, Zip:

___________________________________

Phone:

___________________________________

E-Mail:

___________________________________

Name of Person You are Honoring:

___________________________________

Name of person receiving special notification card (if different):

___________________________________

Recipients's Address:

___________________________________

City, State, Zip:

___________________________________

Reason for making tribute gift (death, birthday, etc.):

___________________________________

Amount of gift (this information is confidential):

$__________

Payment Type:

__ Check __ Credit Card

If Credit Card:

__ MC __ VISA __ AM/EX __Discover

Card Number:

___________________________________

Expiration Date:

___________________________________

Signature:

___________________________________

© Copyright 2002-2004 American National Red Cross. All rights reserved.
American Red Cross of Rhode Island • 105 Gano Street • Providence, RI 02906
(401) 831-7700 • TOLL FREE 1-800-842-1122

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