Donor Information
First Name  * 
MIddle Name or Initial
Last Name  * 
Organization (If Applicable)
Phone Number
Organization Phone Number
Address  * 
City  * 
State  * 
Zipcode  * 
Giving Circles: Gifts of $100+ are included in one of our Support Levels and highlighted in our Annual Report
Life Enrichment Fund Support Levels  * 
Donation Amount  * $ 
Donation Frequency  * 
If your donation frequency is more than one time, please indicate the total amount you would like to pledge
Do you want to designate your gift to a specific purpose?  * 
If Yes, please choose from the list below or type your designation in here
Designation Choices  * 
Housing: Specific Community
Tribute Information
Tribute Name
Do you want us to send a letter to the family on your behalf notifying them of your gift? (no dollar amount will be stated in the letter)
If Yes, please indicate the name and address of the family member you wish us to notify:
Additional Comments
Payment Options
Please select the following  * 
By Mail: Please mail your check and printed form to: United Church Homes 170 E. Center St PO Box 1806 Marion, OH 43301-1806
By Phone: The Advancement Department (740) 223-2032 or Toll Free (800) 837-2211 ext. 2032
Your Email Address  * 
Total $
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