Mail-in and Fax Donation Form

Fill out the following information. Then print this form and fax or mail along with your check
(if applicable) to:

Vision House
P.O. Box 2951
Renton, Washington 98056

or Fax to: 425-430-9590

 
Donation Amount:

$25, to provide a bag of groceries for one family.

$50, to provide a bag of groceries for two families.

$100, to provide shelter and services for a family for one week.

$200, to provide shelter and services for a family for two weeks.

$800, to provide shelter and services for a family for two weeks.

Other Amount, to care for as many families as possible:

 
Contact Information:
Name:
Address:
Company:
 City:
State:
 Zip Code:
Country:
    
Phone:
Email :
Gift Recipient Information
If giving as a gift, please fill in the name of the recipient and we will send them a lovely card announcing your gift. If you are purchasing a courtyard brick, they can then choose to be notified when the courtyard is complete so they can come see your gift to them during our ribbon cutting ceremony.

Gift Recipient:
Name:
Address:
City:
State:
Zip Code:
 Email :
Provide Information ONLY If Paying by Credit Card:
Type Of Card:
Card Number:
Name On Card:
Expiration Date:
(mmyy)
Join Our Mailing List:

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