American Red Cross - York/Poquoson Chapter : Gift Form

I want to make a difference by supporting the York-Poquoson Chapter of the American Red Cross through a gift as follows:


Donor Information:
Name ____________________________________________ Address __________________________________________ City, State, Zip ____________________________________ Phone __________________ E-mail ________________________

Gift Information:
____	Check in the amount of $ _________________ enclosed
____	Credit Card in the amount of $ ____________________ Credit Card Type: ___________________________________________ (VISA, MasterCard, American Express, or Discover Card) Credit Card No.: ______________________________________________ Expiration Date: ____ / ______ Name as it appears on card: ___________________________________
____	Gift Of Securities Security: ___________________________________________ Number of Shares: ______________________________________________ (We will contact you to arrange for transfer of securities.)

Gift Details:
____	My employer will match my contribution. __________________________________________ Employer Name. (Please enclose matching gift form.)
____	I/We prefer to be listed as anonymous.
____	Please send me information on bequests and other means of deferred and planned giving.

Mail To:	American Red Cross York-Poquoson Chapter 6912 George Washington Memorial Hwy. Yorktown, VA 23692
If you are using your credit card, you may fax this form to (757) 898-3886. For questions about other gifts you'd like to give, please call (757) 898-3090. Thank you for your gift to the York-Poquoson Chapter of the American Red Cross.