Fillable Printable Lock's of Love Hair Donation Form
Fillable Printable Lock's of Love Hair Donation Form
Lock's of Love Hair Donation Form
TO ENSURE SAFE ARRIVAL, PLEASE DO NOT SEND DONATIONS IN LETTER SIZE ENVELOPES
Please mail your donation to: Locks of Love – 234 Southern Boulevard – West Palm Beach, FL 33405
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Please complete, print and send this form with your donation.
If you wish to send in photos of your donation, please e-mail them to photos@locksoflove.org with name & address.
Donor Information (please print or type)
Name
Phone
Address
Suite/Apt
City & State
Age (if minor)
Zip Code
Today’s Date
E-MAIL:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Please select how you would like to receive your acknowledgment (choose one)**:
Mail _________ E-Mail__________
**
Please note to receive an acknowledgment by mail may take up to 90 days. By selecting
to receive an e-mail acknowledgment, Locks of Love will be able to send your
acknowledgment more promptly.
Contribution Information
(optional)
I would like to donate: ___ $25 ___$50 ___ $100 ______ Other Amount
Sponsor a Locks of Love child
___$1,000
Payment type: __ American Express __Visa __MasterCard __ Check # ________ __MO
Credit card number: Exp. Date:
Name as it appears on card:
Please make all checks or money orders payable to:
Locks of Love
Comments
Thank you for your donation!
