DONATION FORM

Partners in Progress, 329 N. Fairfield Street, Ligonier PA 15658
(724) 238-9204 tel -- (724) 238-4603 fax --
info@piphaiti.org

To make a donation, please print the following form, fill it out completely, and mail it along with your check or money order to the address listed above. Please make checks payable to Partners in Progress (PIP)

I would like to make a:  one time  monthly gift of:

 $5    $10   $25   $50   $100     Other__________

Please fill in your name and address completely to insure correct preparation of your receipt for tax purposes.

Name ___________________________________

Address __________________________________

 ___________________________________

City ________________ State ____  Zip _____

Phone  _______________

Email __________________________________

I want to request that my gift be used for

 The GREATEST NEED!

 St. Antoine school
 Fatima House children’s home
 APF medical clinic
 APF medical laboratory
 APF vocational School
 University of Fondwa
 Educational Outreach in the US
 Educational tourism scholarships

 Other _________________________

Thank you for your support!