RETURN TO WEB SITE
Please print out this form for corporate and personal donations.

   Donor Name or Corporation Name
 

   __________________________________________________________________________________

   If corporate, please give name and title of contact:
  

   __________________________________________________________________________________

   Complete Mailing Address:
 

   __________________________________________________________________________________
 

   __________________________________________________________________________________
 

   __________________________________________________________________________________

   City

State

Zip

  
   Amount of contribution / corporate matching gift: $________________________________

   In memory of __________________________________________________________

   In honor of ____________________________________________________________

   Type of gift, other than cash: (e.g. Securities, Bequests, Charitable Trusts, etc.)
 

   __________________________________________________________________________________  

   Name and address of person or organization to receive acknowledgment of this donation:
 

   __________________________________________________________________________________
 

   __________________________________________________________________________________
 

   __________________________________________________________________________________

   City

State

Zip

Please make your tax-deductible contribution payable to:
Senior Quality of Life Foundation, Inc., PO Box 497, Andover, NJ 07821
Senior Quality of Life Foundation, Inc. is a 501 (c) (3) organization.
Your contribution is tax deductible to the extent provided by law.