Donate by Mail

DONATE BY MAIL

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Print out this form and send with check or credit card information to one of the following addresses:

Planned Parenthood of North Texas
7424 Greenville Ave., Suite 206
Dallas, TX 75231
(214) 363-2004
fax (214) 696-2091 Planned Parenthood of North Texas
301 South Henderson St.
Fort Worth, TX 76104
(817) 878-2650
fax (817) 882-1166

YES! I want to keep reproductive choice available and help the thousands of women, teens and families who rely on PPNT’s family planning health care services and educational programs.

Enclosed is my contribution, made payable to PPNT in the following amount

$500 $250 $100 $75 $50 $25 Other $_______

Please charge the amount indicated above to my

Visa MasterCard Discover

Account Number: ___________________________________________________

Name as it appears on card: __________________________________________

Exp. _________ Signature: ___________________________________________

Donor Information

Salutation: Ms. Mrs. Mr. Mr. and Mrs. Dr. No Selection

First Name _______________________ Last Name _______________________

Address: _____________________________________________________________

City __________________________________ State _______ Zip ___________

Phone Number _______________ Email Address (optional) _________________

Please type your name exactly as you wish to be listed in various agency publications.

_____________________________________________________________________

I do not wish to receive donor recognition in various agency publications.

Make this contribution:
In memory of In honor of Other (please specify) ___________________

Honoree Name(s) _______________________________________________________

Send Acknowledgment Card to

Name(s) ______________________________________________________________

Address ______________________________________________________________

City __________________________________ State _______ Zip ___________

Additional Information

I have enclosed my company’s matching gift form.

Please send me information about planned giving, including gifts that return lifetime income and other tax benefits.

May PPNT contact you in the future? Yes No