Mail-in Donations Form

Print this form and mail it with your tax deductible donation in any amount to:

Executive Director
Jane Doe Inc. 
14 Beacon Street, Suite 507 
Boston, MA  02108

First name: _____________________________________
Last name: ______________________________________
Company: _______________________________________
Street Address : ___________________________________
Street Address 2: __________________________________
City: _____________________ State: ____  Zip: __________
Phone Number (day):  _______________________________
Phone Number (evening): ____________________________
Email Address :  _____________________________________
My Company will make a Matching Gift (Y or N):  __________
If Yes, Company Name: _______________________________
Additional comments
regarding this donation: _______________________________
____________________________________________________
____________________________________________________
____________________________________________________

Enclosed please find my contribution of $                 so Jane Doe Inc. can continue to work towards a future free of domestic violence and sexual assault.  Under IRS code, because no goods nor services were exchanged for your donation, you may deduct the full value of your gift as a charitable contribution to a qualified 501(c)(3) organization.  


Thank you for your time and commitment to ending domestic violence and sexual assault. You will receive a letter acknowledging your gift which you may use for tax purposes.