Purchase a Square Foot Form

Purchase a Square Foot - Donation Form

Yes, I want to purchase ______ square feet/foot at $79.50 each. My total donation is $__________________________

I am unable to donate a square foot. Here is my donation of :

� $20 � $50 � $100 � Other ____________

Please make check payable to Habitat for Humanity. To use a credit card, please provide the account information and sign below, or call 921-6623.

_____ Visa _____ Mastercard

Card Account No.: ________________________________________________

Amount: _______________________

Cardholder Name: _______________________________

Expiration Date: ___________________________________

Authorized Signature: _________________________________________________________________

Please print and mail to 88 South Portland Street, Suite 213, Fond du Lac, WI 54935. Thank you!