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Please print this form to accompany your mail-in donation. Keep the bottom portion as your receipt.
DONOR INFORMATION
| Name | __________________________________ | |||||
| Address | ____________________________________________________________ | |||||
| City | __________________________________ | State | _____ | Zip | ___________ | |
| Country | __________________________________ | |||||
| __________________________________ | ||||||
| Phone | __________________________________ | |||||
DONATION INFORMATION
| I would like to make a donation to the following Three Guineas Fund grant partner: ______________________________________________________________ |
| Amount: $ ______________________________ |
Please make check payable to the Three Guineas Fund. The Fund will forward 100% of your gift to the organization you have identified above. All donations are tax-deductible.
Mail check to: Three Guineas Fund, 153 Upper Terrace, San Francisco, 94117
| Receipt for donation to the Three Guineas Fund, a 501(c)3 organization, | for: | ________________________________ (name of recipient organization). |
| Date: | ______________ |
| Amount: | $ ____________ |
| Check #: | ______________ |
| Description: | ___________________________________________________________ |
The entire amount of your contribution is deductible to the maximum extent provided by law, as no exchange of goods or services has been provided as consideration for your gift.
For your information, the Three Guineas Fund tax identification number is 943215954.