Agape Ranch Donation Mail-in Form

Print and return this form to Agape Ranch at the address or fax number below to send a donation. 

 

(please print)

First Name:                                                                                                                   __

Last Name:                                                                                                                   __

Address:                                                                                                                       __

City:                                                                                                                             __

State:                                                                                                                            __

Zip Code:                                                                                                                      __

Phone:                                                                                                                          __

Email Address:                                                                                                  ________

Type of Donation (please check one)

Credit Card _____              Check ____                Cashier’s Check ____

 

Amount of Donation: ___________________________________________________

 

Billing Information

Name on Credit Card:                                                                                                    __

Billing Address:                                                                                                 ________

City:                                                                                                                             __

State:                                                                                                                            __

Zip Code:                                                                                                                      __

 

Type of Credit Card

Visa __                          MasterCard __                        Discover __

Credit Card Number:                                               _____________________________

Expiration Date:                                                ________________________________

Signature:                                                          ________________________________

Is this gift in memory of someone special or in honor of a special event?   Yes____  No____

If yes, please explain. ____________________________________________________

 

Please send your donation to:

Agape Ranch

10104 Foxridge Court

Highlands Ranch, Colorado 80126

Fax: 253.390.1233

 

Thank you for supporting our efforts to provide hope and healing to those battling cancer.