Donation Form

Thank you for supporting our mission. Please print this form and include it with your donation.

I want to give a one time gift of: $__________.

Payment:

Check Enclosed
Charge my credit card

My company will match my gift.

Credit Card Information:

            Visa                   Mastercard

Card # ____________________________________________

Expiration Date _____________________________________

Name on Card _____________________________________

Signature _________________________________________

Date ____________________________________________

Donor Information:

Name: __________________________________________________

Organization: _____________________________________________

Address: ________________________________________________

City: __________________ State: ______________ Zip :__________

Phone: ( _______ ) ____________________

E-mail: _____________________________

Please mail or FAX this completed donation form to:

Rainier Scholars   2100 24th Avenue S, Suite 210  Seattle, WA 98144
Phone:  (206) 407-2111              Fax:  (206) 407-2112