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Donation Mail-In Form

To donate by mail to The Children's Aid Society, print out this form, fill it in and fax or mail it to:

The Children's Aid Society
105 East 22nd Street, Room 504
New York, NY 10010
Tel.:(212) 949-4936
Fax: (212) 477-3705

I would like to support the work of The Children's Aid Society with a donation of $_________.

Personal Information

Name: __________________________________________________________
Street Address: ___________________________________________________
City: ________________________ State: _____ Zip Code: _____________
Daytime Telephone: ________________________________________________
Email: __________________________________________________________

Gift Type

I would like my gift to be used for:
_____ General Operating Funds
_____ Other (Please specify): ________________________________________

_____ I wish my gift to be anonymous.

Payment Method

_____ Enclosed is my check or money order for $_____________.

Please make checks payable to "The Children's Aid Society."

_____ Please charge my credit card Amount: $__________

_____ Visa _____ MasterCard _____ American Express

Card Number:____________________________________________________

Expiration Date: __________________________________________________

Name on Card: ___________________________________________________

(if different from above) )

Signature: ____________________________________________________ ___

Tribute Information

If this gift is made in honor or in memory of someone, please check below:

_____ In Honor _____ In Memory
Name of Honoree: _________________________________________________

To whom should we send an announcement of your gift?
(We will not tell them the dollar amount, only that we have received a donation from you.)

Name: __________________________________________________________
Street Address: ___________________________________________________
City: ________________________ State: _____ Zip Code: _____________
The Children's Aid Society   |   105 East 22nd St.   |   New York, NY 10010   |   212-949-4800 (Main)   |   212-949-4936 (Development)