For Haiti With LoveTo help with making a contribution to For Haiti With Love you can print out this form then fill it out and mail it along with your contribution to For Haiti With Love. To print the form click on your browsers File menu option then click on print. To return to the previous page click on your browsers back button.

Name


Address

City                                                                                     State           Zip+4

E-Mail Address

Please use this tax-deductible contribution for:

Where Needed
Food Program
Medical Program
Construction Program
Other_____________________________________________________________________
In Memory Of:___________________________________Relationship__________________
In Honor Of:___________________________________Relationship__________________

Send contributions to:

For HAITI With Love
P.O. Box 1017
Palm Harbor, FL 34682-1017

Comments, requests or names to add to the mailing list:





Thank You for your contribution. Gifts to For Haiti With Love are deductible as charitable contributions. Our mailing list is confidential, we don't loan, sell or share!