Contributing to Northwest Family Services, Inc.
Contribution Pledge
Your contribution is dedicated to client-related services. Please know that your gift may be tax deductible as we are a 501 (c) 3 organization.
Please print this page and print clearly the needed information, then send to:
Northwest Family Services, Inc.
620 Flynn Street
Alva, OK 73717
Name:______________________________________
Address:____________________________________
City/State/Zip:______________________________
Daytime Phone (____)________________________
______ One time Gift of $_____________
______ Annual Gift of $_______________
______ Monthly Gift of $ _____________
_______Yes I would like for my contribution to be automatically debited from my account
If you checked "Yes" please fill out the information below:
Bank Name:_______________________________ Routing Number: ________________________
Account Number:__________________________
Signature:_________________________________ Date:___________________________________