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      Children’s Shelter of Blackstone Valley

     15 Gates Street

      Pawtucket, RI 02861

 

 Your Name:________________________________

 

 Address:___________________________________

 

 City/State/Zip: ______________________________

 

 Make Check payable to: CSBV

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Please charge to my credit card:

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                                                        Exp. Date ____________

                                                       ___________________________

                                                         Signature

 

 

 

If you would like this donation to be a tribute,   please provide the       acknowledgement information below:

 

           _____ In Honor of                       ___ In Memory  of

 

  Name of individual: ____________________________________

 

  Address:_____________________________________________

 

   City/State/Zip:________________________________________

 

   Occasion: ___________________, _________________________

 

  Amount: _____________

 

   Thank you for your contribution.  All donations are tax-

   deductible as provided by law; we are a 501  (c) (3) Corporation.

 

  Please be sure to check with your employer; many companies

   will match charitable contributions made by their employees.

 

 Your donation will directly benefit the children.

                                                  

                                           To contact us:

                                       Phone 401 722 4626

                                       FAX 401 727 2967

                                       Email: childrensshelter@cox.net

 

  Donation Form