Humane Society of Pagosa Springs

JOIN THE HOMEWARD BOUND $1000 CLUB!

Fill out form, print page, and send (if paying by check, make payable to Humane Society of Pagosa Springs and mark for Homeward Bound) to:

   Humane Society of Pagosa Springs
   PO Box 2230
   Pagosa Springs, CO 81147

Name:

Address:

City:

State: Zip:

E-Mail:

I want to join the $1,000 Club and will give $1,000

I can give more and will donate

I can't stretch to $1,000 but want to help in the amount of

Payment

Check is enclosed

Charge to Visa Mastercard American Express

Name on Card:

Credit Card #:

Exp. Date:

Billing Address if different from address above:

I prefer not to have recognition on a garden paver

Inscription for paver (3 lines with up to 20 characters per line; can also specify a paw or heart in place of 4 characters):

Your tax receipt will be mailed to you. If you have any questions or want to learn about other options, call 970-264-5549 or email homewardbound@centurytel.net.

If paying by credit card, you can fax this form to 970-264-5593.

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