Name___________________________________________________________________ 

Address_________________________________________________________________ 

City_______________________________________State_____________Zip_________ 

Phone__________________________________________________________________

My gift is in Memory ___     or in Honor___      or a Holiday Gift ___ 


Enclosed is my gift of $__________________

Please charge my gift of $________________  

Visa_________ or Master Card _____________     Exp. Date_________________________

Acct. #___________________________________________________________________

Signature________________________________________________________________

Your name as you would like it to appear on the card ________________________________

Send card to_______________________________________________________________

Address__________________________________________________________________

City____________________________  State____________     Zip____________________

Please feel free to include additional honorees on a separate piece of paper

Please mail completed form to: 
Habitat for Humanity of Charlotte
P.O. Box 220287 Charlotte, NC 28222

Fax to: 704-342-1797
Phone: 704-716-7073