Donation Form - Little Red Hen

Donation Form
Please print this form to mail your gift to
Little Red Hen
14555 Cameron Park Drive
Chico, CA 95973
Little Red Hen, INC is a 501 (c)(3) Corporation. All donations are 100% tax deductible.
* = required information
I would like to give to:* (please check one choice)
________Where the Need is Greatest
__________Park & Garden
______Pantry COOP
________SH Fund (severely handicapped classrooms)
________Cleo Hill (teachers going in to Special Education)
________Autism LifeSpan
________Swim Program
________Bike Camp
Other (please specify)_______________________________________________
Donation Amount* $ ______________
First Name* _________________________________________________________
Last Name* _________________________________________________________
Street Address* ______________________________________________________
City* ______________________________________
State*______________ Zip Code*_______________
Phone Number _______________________________
E-mail ______________________________________
I prefer to make my donation by:
____ Check or Money Order (made out to "Little Red Hen")
____ Credit Card (please enter information below)
_____ Visa
_____ Mastercard
Credit Card Number ________________________________ Exp. Date _________
Signature ___________________________________________________________
Thank you for your gift!