The Astor Home For Children Foundation

DONATION FORM

Enclosed is my/our contribution of $___________

My pledge total is $___________ to be paid in the month(s) of _______________

My employer has a matching gift program and my employer is:

____________________________________________

Matching gift form enclosed ____ No form required ____

Please charge my credit card $___________

Card type:__________ Exp. Date: ___________

Card # ____________________________________________
 

Signature: _______________________________________________
 

Name: __________________________________________

Address: ________________________________________

City/State: _______________________________________ Zip:_____________________

If you wish, your gift may be designated:

In Memory of: ________________________________

In Honor of: (name)__________________________________

__________________________________
(occasion)

Please send acknowledgement to:

Name: ______________________________________

Address: ____________________________________

City/State: ___________________________________ Zip:_____________________

Name as you would like it to appear in our Annual Report:
 
______________________________________

Thank you for your generous support!
Your donation is used to benefit the children and families in Astor’s various programs.

Please make checks payable to:

The Astor Home for Children Foundation
P.O. Box 5005
Rhinebeck, NY 12572-9913

Donors will be listed in the annual report unless otherwise requested.
Contributions are tax deductible to the maximum extent allowed by law.