fax order form - Chairs for Charity

Transcription

fax order form - Chairs for Charity
Date:
Company Name:
Account #
Phone #
FAX#
P.O.#
Contact Name:
Address:
Delivery Address (if different from above):
City:
State:
Zip:
Street:
City:
State:
Zip:
MC
OTHER
If paying by credit card, please check box:
AMEX
VISA
Expiration Date:
Credit Card #
Cardholder’s Name (please print):
Signature:
Would you like a phone call confirming this fax?
Item Number
Qty
Unit
YES
Description
AIM Center, Inc.
Alexian Brothers Senior Neighbors
American Heart Assoc.
American Red Cross, Greater Chattanooga Area
Big Brothers/Big Sisters of Greater Chattanooga
Walter Boehm Birth Defects Center
Boy Scouts of America, Cherokee Area Council
Boys & Girls Clubs of Chattanooga
Catholic Charities of Chattanooga
Chattanooga Goodwill Industries
Chattanooga Room in the Inn
Chattanooga’s Kids on the Block
Children’s Academy for Education & Learning
Children’s Home/Chambliss Center
Communities in Schools of Catoosa County
Council for Alcohol and Drug Abuse (CADAS)
Epilepsy Foundation of Southeast Tennessee
Family Crisis Center of Walker, Dade, Catoosa & Chattooga Counties
Fortwood Center
Four Points
Gifts In Kind
Girl Scouts of Moccasin Bend Council
Girls Incorporated of Chattanooga
Hospice of Chattanooga
Jewish Community Federation of Greater Chattanooga
LaFayette Area Empty Stocking Fund
Little Miss Mag Day Care Center
Maurice Kirby Child Care Center
Northside Neighborhood House
Ochs Center for Metropolitan Studies
Orange Grove Center, Inc.
Partnership for Families, Children and Adults
Pro Re Bona Day Nurseries
Primary Health Care Center of Dade County
RE:START - The Center for Adult Education
The Salvation Army
Signal Centers
Special Transit Services
Speech & Hearing Center
The Team Centers
Tri-State Food Pantry
United Way of Greater Chattanooga
United Way’s Project Ready for School
United Way’s 211 Information & Referral Service
United Way’s Volunteer Center
United Way’s Building Stable Lives
Urban League of Greater Chattanooga
Volunteer Community School, Inc.
Walker County 4-H
YMCA
Price
FAX ORDER FORM
I want my Chairs for Charity donation to be made to:*
NO
*Please circle the name of the organization to which you wish to donate.
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discover how
you can support your
employees and
United Way partner
agencies at the same time.
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