Name:
Address:
City, State, Zip:
Phone Number:
E-mail Address:
|
|
|
|
|
| Yes – I would like to make a donation to Surrey Services for Seniors! | |
|
Name: |
|
|
Address: |
|
|
City, State, Zip: |
|
|
Phone Number: |
|
|
E-mail Address: |
|
|
|
|
| I would like my gift to be used for: | |
| q | The Broomall Location | |
| q | Activities | |
| q | Consignment | |
| q | Home Care | |
| q | Transportation | |
| q | Volunteer Programs | |
| q | Unrestricted – wherever it is most needed | |
| Please make checks payable to
Surrey Services for Seniors
Please return this form to: |
||
| Surrey
Services for Seniors 28 Bridge Avenue Berwyn, PA 19312 |
||