Aging Enriched Donations

Lutheran Homes of Michigan, Inc. is a 501(c)(3) organization. Please consult your tax advisor regarding deductibility.

This gift is given by:

Title

Mr.	Mrs.	Miss	Ms.	Dr.
Rev.

First Name:

*

Last Name:

*

Spouse First Name:

Spouse Last Name:

Address:

*

City:

*

State:

*

ZIP:

*

Phone:

*

Email:

*

Check here if you do not wish to receive promotional material.

Please do not send me promotional material.

Please use this gift for:

Please list your name(s) as you would like it to appear in the Highlights, our quarterly newsletter:

This gift is in:

Honor of Memory of

Please acknowledge this gift separately to:

Name

Address:

City

State:

ZIP

Payment options:

Card Type:

*

Visa	Mastercard
American Express	Discover

Card Number:

*

* * *

Expiration Date:

*

/*

3 or 4 digit Security Code (on back of card):

*

Contribution Amount:

*

Please fill in the letters and numbers at right before submitting your donation:

*