13700 La Mirada Boulevard, La Mirada, California 90638

Donor Response Form
(Please print this form, complete & return to the address listed above.)

 Please check all that apply: 

I would like more information about the La Mirada Community Services Foundation

I would like to speak with a Foundation representative about a donation

Please accept my enclosed donation by check in the amount of $_____________      

Please accept my credit card donation in the amount of $ ___________

(Please circle one of the following and complete the information)

Visa      Mastercard                #___________________________      Expiration date_________
  

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Print Name                                                                                Signature (for credit card donations)

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Address

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Phone                                                                                                  Best time of day to be called

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E-mail address

Please make checks payable to: La Mirada Community Services Foundation

For more information, call (562) 943-0131.