MARYLAND BICHON FRISE RESCUE, INC. DONATION FORM

Use this form to make donations to support the programs of
Maryland Bichon Frise Rescue, Inc.

PRINT and complete this form. If paying by VISA or MasterCard, fax to Jill at 301-762-6422.
If paying by check or money order, mail form with payment. Make checks payable to MARYLAND BICHON FRISE RESCUE, INC. and mail to Jill Siegel / 13400 Valley Dr. / Rockville, MD 20850.

Name
Billing Address
City, State, ZIP
Daytime Phone
Email Address
Payment: VISA____ MasterCard_____ Check/Money Order____
Card Number
Expiration Date (mm/yyyy)
CVV2/CVC2/CID
3-digit number on
card signature panel

Enclosed is my tax deductible contribution of $

Is your donation being made:

___ As a general donation to Maryland Bichon Frise Rescue, Inc.

___ As a donation to help the FEMA-certified Urban Search & Rescue Teams of Montgomery County, MD and Fairfax County , VA

___ In Memory Of: ______________________________________________________

____ In Honor Of: _______________________________________________________________

Please send an acknowledgement to:

____ Me, at the address listed above, and/or

Name _________________________________________________________________

Address ________________________________________________________________

City, State, ZIP Code ______________________________________________________

Maryland Bichon Frise Rescue, Inc. is a Maryland corporation and all-volunteer, nonprofit organization.
Maryland Bichon Frise Rescue, Inc. is recognized by the Internal Revenue Service as tax exempt pursuant to Section 501(c)(3) of the Internal Revenue Code.

All donations are 100% tax deductible.
Thank you very much!