Habitat Philadelphia

The affordable housing crisis in Philadelphia is severe but together we can rebuild communities
by providing homeownership opportunities to hardworking families. Thank you for helping to build
hope by building homes.

Please consider our Monthly Giving program. You will help us save on administrative costs
and provide us with income that we can rely on as we plan our building projects.

Please note that fields with an asterisk (*) are required.

You can use a Visa, Mastercard, American Express, or Discover Card with this form.

Title / *First Name	*Last Name

*Street or PO Box	Apt/Suite /Floor Number

*City	*State
*Zip
Ph Fx	*Email

*This transaction is for a:

If Other

Please be sure that all of the following information is correct.
*Frequency	*Amount $
*CC Number	*Exp Date /
**Monthly/Quarterly Consent Agreement As a Monthly or Quarterly contributor,�I authorize the amount indicated above to be transacted with the indicated frequency.��I understand that a record of each contribution will appear on my monthly credit card statement.��I can discontinue these transactions at any time by notifying Habitat Philadelphia
*Please select one option:

Please indicate below if your gift should be for a memorial or honoree.
	In memory of (please enter name of loved one)
	In honor of (please enter name of honoree)
Notification is to be sent to the following names(s) and address(es):

Are you a member of any congregation or organization that might be interested in working with Habitat Philadelphia? If so, please provide contact information below.

After ensuring that all of the above information is correct,
please click the "Submit Form Now" button ONLY ONCE

If you provided an EMail address you will receive a confirmation of this action.

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