Helpers Fund - Holiday Drive Form

Annual Holiday Drive

Please indicate your choice, or choices, of those areas that you would like to assist during this holiday period. If you are choosing more than one area, write on each line how much you would like allotted to that area. If you wish to attach a message to any gift or gifts your donation provides, please fill in the appropriate lines below.

Take a moment now to make your choice, or choices, and make sure you have checked the appropriate lines. Make out your check to "Helpers Fund Inc." for your total amount, or fill in the credit card information, and mail this form to the Helpers Fund. Thank you for your generosity and your thoughtfulness!

Please direct my Holiday Drive contribution as indicated:
$_______ Adopt-A-Family

$_______ Food Program

$_______ Chestertown/Helpers Fund Food Pantry

$_______ Winter Clothing

$_______ Discretionary - To be used by the Fund where most needed

Name _______________________________________________________________

Address ____________________________________________________________________________

City ___________________________ State __________ Zip ________

Phone# (____) ___________________ E-mail address _________________________________________

Brief message to be attached to your gift(s) - optional:
____________________________________________________________________________________________
____________________________________________________________________________________________

Total amount of contribution $ __________
Paid by check ____ (payable to Helpers Fund Inc.) Credit card ____ (please complete credit card information below)

Name as it appears on credit card _________________________________________________________

Address of cardholder, if different from above ___________________________________________________________

__MC __Visa Account number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp: mo___ /yr___

Amount to be charged: $_____________ Signature: ________________________________________

Print, complete and mail this page to:
The Helpers Fund
c/o Edna Wells
P.O. Box 173
Pottersville, NY 12860

Thank you for your support!

The Helpers Fund is a 501(c)3 charity under the rules of the Internal Revenue Service and is incorporated under the laws of the State of New York and listed with the New York State Bureau of Charities.

Last updated December 2011
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