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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.