Donation Form

I would like to make a difference in the lives of hundreds of children impacted by homeless!!
Name:  ________________________________________
Address  _______________________________________
City:  _________________ State: _________ Zip: _______
Phone Number: __________________________________
E-mail: _________________________________________
Please accept my check Enclosed) for the amount of $_____
Please charge my :   Visa MasterCard  Discover
Card Number; _______________________ Exp Date:__________
Signature: ___________________________       Amount Charges: $ _________
If your donation is $500 or more, please indicate how you would like your name to appear in our annual report: _________________________________________________
My gift is in memory of: _____________________________________________
My gift is in honor of: _______________________________________________
Please acknowledge my gift with the appropriate tribute card to:
Name: ____________________________________________________________
Address: ___________________________________________________________
City/State/Zip: _______________________________________________________
I have included Youth Haven Ranch in my will.
I would like more information about planned giving.

All gifts are tax-deductible as allowed by law.  For more information, please call us at 815-947-3414
THANK YOU!

7385 S. Illinois Route 78, Stockton, Illinois 61085
Ph: 815-947-3414  Fax: 815-947-6080   yothhavenranch@netzero.net