Habitat for Humanity of Montgomery County is dedicated to eliminating poverty housing and partnering with families to build safe, simple, decent homes in Montgomery County. Your contribution is an investment in your community. Fields marked * are required Description * — Select One —General DonationJohn Cooper School HouseDonation in Memory ofDonation in Honor of Dollar Amount (Do NOT include “$” – numbers only) * Information must match information on your credit card statement. Title — Select One —Dr.Mr.Mrs.Ms.Miss First name * Last name * Company Click here to see if you or your spouse’s company matches your donations! Address * City * State/Province * — Select One —Non US/CanadaAK – AlaskaAL – AlabamaAR – ArkansasAZ – ArizonaCA – CaliforniaCO – ColoradoCT – ConnecticutDC – District of ColumbiaDE – DelawareFL – FloridaGA – GeorgiaHI – HawaiiIA – IowaID – IdahoIL – IllinoisIN – IndianaKS – KansasKY – KentuckyLA – LouisianaMA – MassachusettsMD – MarylandME – MaineMI – MichiganMN – MinnesotaMO – MissouriMS – MississippiMT – MontanaNC – North CarolinaND – North DakotaNE – NebraskaNH – New HampshireNJ – New JerseyNM – New MexicoNV – NevadaNY – New YorkOH – OhioOK – OklahomaOR – OregonPA – PennsylvaniaPR – Puerto RicoRI – Rhode IslandSC – South CarolinaSD – South DakotaTN – TennesseeTX – TexasUT – UtahVA – VirginiaVT – VermontWA – WashingtonWI – WisconsinWV – West VirginiaWY – Wyoming Zip/Postal code * Phone number * E-mail address * (for donation confirmation) Significant Other First and Last Name Credit card information will be collected on the next page. I wish to remain anonymous Yes No If you are giving a gift in honor or in memory of an individual, please fill in the individual’s name below: In Honor of Name In Memory of Name The fields below are required if an honorary or memorial name was provided above.The information allows HabitatMCTX to notify the honoree or family of your gift, however the amount will not be included with the notification First name Last name Address City State/Province — Select One —Non US/CanadaAK – AlaskaAL – AlabamaAR – ArkansasAZ – ArizonaCA – CaliforniaCO – ColoradoCT – ConnecticutDC – District of ColumbiaDE – DelawareFL – FloridaGA – GeorgiaHI – HawaiiIA – IowaID – IdahoIL – IllinoisIN – IndianaKS – KansasKY – KentuckyLA – LouisianaMA – MassachusettsMD – MarylandME – MaineMI – MichiganMN – MinnesotaMO – MissouriMS – MississippiMT – MontanaNC – North CarolinaND – North DakotaNE – NebraskaNH – New HampshireNJ – New JerseyNM – New MexicoNV – NevadaNY – New YorkOH – OhioOK – OklahomaOR – OregonPA – PennsylvaniaPR – Puerto RicoRI – Rhode IslandSC – South CarolinaSD – South DakotaTN – TennesseeTX – TexasUT – UtahVA – VirginiaVT – VermontWA – WashingtonWI – WisconsinWV – West VirginiaWY – Wyoming Zip/Postal Code Relationship to person being remembered Contributions to Habitat for Humanity of Montgomery County are tax-deductible to the extent allowed under IRS guidelines. ‘
