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  2. Complete by hand
  3. Fax or mail to WE MOVE

Donation mail/fax form

WE MOVE
204 W. 84th Street
New York, NY USA 10024

Tel: 866-546-3136
Fax: 212-875-8389
Email: wemove@wemove.org
Web site: www.wemove.org

DONOR INFORMATION
Name:  
Address:  
City:  
State/Province:  
Country:  
Zip Code:  
Tel:  
Fax:  
E-mail:  
Check here if you are including
a matching gift from your employer:		  __
 
PAYMENT INFORMATION
 
__ Check enclosed   __ Charge to my credit card   __ Visa   __ Mastercard   Amount $______________
Name of cardholder
(exactly as printed on card):		  
 
Card number:  
Expiration date:  
Signature of cardholder:  
 
OPTIONAL
I would like to make my donation in honor of:  
 
Please send a notice to Name:  
Address:  
City:  
State/Province:  
Country:  
Zip Code: