Fillable Printable Hair Donation Form - Children with Hair Loss
Fillable Printable Hair Donation Form - Children with Hair Loss
Hair Donation Form - Children with Hair Loss
I HAVE ENCLOSED A$ DONATION TOHELP PAY FORACHILD’S HAIR REPLACEMENT
I HAVE ENCLOSED A$7 DONATION TOPAY FORA HAT TOBE GIVEN TOA RECIPIENT OF CWHL
HAIR DONATION
Hair must be aminimum of 8 inches, clean, DRY,and in a ponytail OR braid.
Place your hair donation into a ziplock bag and then inanymailing envelope.
Pleasesend this completed form along with your hair donation to:
Children With HairLoss
12776 Dixie Hwy
S.Rockwood, MI 48179
(Print Clearly)
Nameof Donor:
Email:Phone:
Please provide your Email allowing us to send your certificate faster, save money and help more kids • International donors receive certificate by Email
StreetAddress: Apt/Suite:
City:
State/Province/Region: Zip/Postal Code: Country:
Please printmy certificate In Memory/Honor Of:
*A certificate of appreciation willbe e-mailed or mailed to you. Please allow up to 6weeksto receiveyourcertificate and t-shirt.
Have you donated to us in the past? Any Comments??
Did you include a picture?Do we have yourpermissiontopublishit? Signature:
Find us on FacebookFacebook.com/CWHLMI &Twitter Twitter.com/cwhl_org and send us a photo and/or comment!!!
We appreciate yourHAIR DONATION,but thereis still aHUGE COST to have a hair replacementmade.
Could you please consider contributing a tax deductibledonationTODAY?
I HAVE ENCLOSED A$20 DONATION TO RECEIVE A T-SHIRT (Please selectsize and color of t-shirt)
SIZE: Youth Medium(Fits up tochild size8) Youth Large (Fits up tochilde size14)
Adult: SM MD LG XL XXLXXXL XXXXL
COLOR (Select One) Black Shirt w/White WritingPink Shirt w/BlackWriting
(YOU CAN SEE THE T-SHIRTS ON OUR WEBSITE)
*If you live outside the United States your order must be placed through our website
www.ChildrenWithHairLoss.us
Checks may be made payable to: Children With Hair Loss
To have your donation chargedtoyour credit card, please fill inyour information below:
Payment Type: Visa Master CardDiscover AmericanExpress
CreditCard Number: Exp Date:
Name as it appearson card: 3 DigitCodeonBack:
Signature of Cardholder:
