Make a Difference

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Domestic Violence

United Family Services
601 East Fifth Street, Suite 400
Charlotte NC 28202
Phone: 704.332.9034
Fax: 704.373.1604 info@ufsclt.org


Make a Difference

To make a gift, please submit the completed form below. For gifts of stock and bank drafts, please call 704.367.2705.

Please note, United Family Services does not share or sell its donor list.

Donor Name (as it should appear in print)

Anonymous?

Do not print my name in agency publications

Organization

Mailing Address

Home or Business

Home

Business

City

State

Zip

Home Phone

Work Phone

Contribution Amount

My company will match my gift

Payment Method

Card Type

MasterCard

Visa

Name on Card

Account #

Expiration Date

Memorial or Tribute Gift

Memorial Gift

Tribute/Honor Gift

Card Recipient's Name (if you wish a card to be sent)

Card Recipient's Address

City

State

Zip

Personalized Message (to be added to card)