| Amount $25 $50 $100 $500 OTHER Name Address City, State ZIP Telephone (Daytime) Telephone (Evening) I would like my gift to be used for a specific program or service. Please specify: Crisis Intervention Programs Case Management Child Care I am employed in a matching gift company Other This gift is: In Honor of In Memory of You may list my name as a donor. I would like to receive more information about Westbay Community Action, Inc. PLEASE PRINT OUT A COPY OF THIS FORM AND MAIL IT WITH YOUR CHECKS TO: Westbay Community Action 224 BUTTONWOODS AVENUE WARWICK, RI 02886 *Please remember Westbay Community Action, on your United Way Pledge Sheet!!* |