Mail-In Donation Form

Please complete as much of this form as possible.  If you have any questions, feel free to call the Portage APL at 330-297-4022 or email questions to info@portageapl.org.  Thank you for caring about the animals!

Please print this page and, when completed, mail it to:

Yes! I want to help further the mission of the Portage APL!  Here is my/our tax-deductible gift to the amount of $__________.

Title:  Mr. __ Ms. __ Mrs. __ Miss __ Dr. __ Prof. __ Rev. __ Other______

Name: _________________________________________________________

Suffix: __ M.D. __ Ph.D. __ J.D. __ Esq. __ M.S.W. __ Other_______

Address:________________________________________________________

_______________________________________________________________

City: ____________________________ State: ____Zip: ___________

Home Phone:______________________ Alternative Phone_______________

Email: __________________________________________________________

You may list my name as a donor. OR Please list me as “Anonymous.”

      My check payable Portage APL is enclosed,

       or charge my:   ___MasterCard  ___ Visa   ___Discover Card

card # __________________________________ exp. date ___/___

security code__________(3 numbers on back of card)

My gift is (Please specify):

  In memory of ___________________________________________

  In honor of______________________________________________
    Please send a special card announcing the gift (but without its amount) to:

Name: _________________________________________________________

Address:________________________________________________________

_______________________________________________________________

City ________________________________ State ____ Zip _______________

Direct my gift:  ___Where need is greatest ___For cat care   ___ For dog care

  ___ Animal cruelty cases    ___ Medical care ___ Spay/neuter fund.

                              Thank You for Caring!